Objective <p>This study aims to explore the preparedness and barriers faced by rural middle-aged and older adults coping with active aging, to reveal the challenges of aging management and provide recommendations for promoting active aging in rural China.</p> Methods <p>This study used a qualitative design with one-on-one semi-structured interviews and purposive sampling to select middle-aged and older adults from rural areas in Tongren, Guizhou Province, China as the study participants. NVivo 14 software and content analysis method were employed to analyze the interview data and extract key themes.</p> Results <p>A total of 17 participants were included in the study. Four main themes were identified: individual-level determinants, family-level determinants, societal-level determinants, and environment-level determinants, along with twenty-five sub-themes.</p> Conclusion <p>The preparedness of rural middle-aged and older adults for active aging is generally low, and they face a complex array of challenges. Multiple sectors of society must develop measures to enhance the awareness of active aging among rural residents, alleviate economic pressures, establish a sound social security system, and promote the high-quality development of active aging in rural areas.</p>