This study aims at exploring factors related to the antenatal care (ANC) utilization in rural areas of Lao PDR. A quantitative, cross-sectional interview study was conducted in the Khammouane and Champasack provinces. The study population comprised all currently pregnant women 15–45 years of age with a gestational period beyond 32 weeks plus all women who had given birth during the last 12 months. With the informed consent of all eligible women, 460 respondents were included in the study and interviewed using a structured questionnaire. Multiple logistic regression analysis was applied to determine factors significantly related to ANC use. Fifty-one percent of the respondents had at least one ANC visit. Among the users, 63% had visited ANC three times or more but only 28% attended during the first trimester. After adjusting for other factors, using a 95% Confidence Interval (CI), statistically significant associations were found between ANC use and the following factors: women whose husbands were salaried employees (OR = 2.66, CI = 1.45–4.88); women younger than 18 years old at first pregnancy (OR 0.56, CI = 0.28–0.97); women perceiving ANC as somewhat useful (OR = 2.88, CI = 1.26–6.61) or very useful (OR = 7.45, CI = 3.59–15.46). Awareness of the usefulness of ANC was related to more frequent use and could be one focus of community intervention to increase utilization.