Background. Mortality rates for hyperthermia and hypothermia are higher in Alabama than nationally, and Alabama has twice as many hypothermia deaths as hyperthermia deaths. These causes of death have not been studied in the southeastern United States. We describe the epidemiology of heat- and cold-related deaths in Alabama. Methods. We examined state mortality data for the years 1987 through 1998 and calculated mortality rates by age, race, and sex. Results. Approximately half the hyperthermia-related deaths were among whites, and approximately two thirds were among males. Of the hypothermia-related deaths, 61.5% were among blacks, and approximately three fourths were among males. The highest rates of hyperthermia- and hypothermia-related death were among black males. Mortality rates increased with age for both causes of death. Conclusions. In Alabama, the elderly and black males are most likely to die of hyperthermia or hypothermia. Public health interventions must be directed toward these groups.