Depression during the perinatal period is common, debilitating, and consequential for women and their children, particularly among low income African American women. Viable approaches to prevention of depression have emerged. Yet little is known about women's preferences for approaches to preventing depression. A sample of 60 pregnant, low-income African American women seeking routine prenatal care was presented with standardized descriptions of three approaches to depression prevention (pharmacotherapy and two psychosocial approaches) and measures of preferences, perceived credibility, and personal reactions to each approach. Women also completed measures of perceived barriers and facilitators and current depression. Consistent with expectations, both of the psychosocial approaches were rated as more strongly preferred, more credible, and associated with more positive personal reactions relative to the pharmacotherapy approach. Depression did not alter women's preferences among the approaches. Contrary to prediction, women with clinically significant levels of depression did not find the pharmacotherapy approach to be more credible or to have more favorable personal reactions to it than women with low depression symptom levels. Exploration of women's perceptions of barriers revealed the importance of logistics, beliefs, and stigma barriers whereas women reported that concern about depression being impairing and ease of pragmatics would both facilitate engagement with preventive interventions. The findings suggest the need to examine the role of preferences in tests of the effectiveness of approaches to the prevention of perinatal depression in order to enhance service delivery among low income African American women.