It is estimated that in the year 2020, approximately 25% of the Japanese population will be over 65 years of age. Moreover, suicide is a significant public health problem in Japan, where more than 6,000 elders take their lives each year. The authors compare late-life suicide in urban Kawasaki with suicide among the elderly in rural Higashikubiki over a 12-year period, from 1979 through 1990. The suicide rates in Kawasaki were lower than for Japanese elders as a whole, whereas those in rural Higashikubiki were extraordinarily high. The most frequent method used in both areas was hanging, and none of the victims died of gunshot wounds. In Higashikubiki, almost two thirds of victims lived in a three-generation family and none lived alone. The change of the family system from the traditional extended family to the nuclear family is accelerating, especially in rural areas. The authors suggest that the greatly elevated suicide rates among the elderly in Higashikubiki, and in rural regions of Japan more generally, result from these rapidly occurring changes in traditional social structure.