Stroke has increased among young adults. In addition, the accuracy by which African Americans perceive their risk of stroke is unclear. The purpose of the study was to examine the accuracy of perceived stroke risk of African Americans aged 19–54 years. A descriptive-correlational design was used. Accuracy of perceived stroke risk was determined by comparing perceived risk with actual risk. Participants (N = 66) had a mean age of 43.3 (SD = 9.4) years and were mostly female, high school graduates, and unemployed. Most (66%) perceived themselves as having no/low risk of future stroke. However, actual risk factors averaged 2.98 + 1.63 of 8, placing 59% of the sample in the moderate–high category of actual stroke risk. Comparisons of perceived and actual risk showed that 44% underestimated their risk, 47% were accurate, and 9% overestimated their risk. Strategies to address risk misperceptions should be explored to improve accuracy of perceived stroke risk and culturally relevant interventions to reduce stroke among African Americans.