Cardiac rehabilitation is a key component of the comprehensive care of the 79.4 million adults in the United States with one or more forms of cardiovascular disease. Only a fraction of eligible candidates complete cardiac rehabilitation and women are at a significantly higher risk for underutilizing this safe and effective secondary prevention intervention. This article reviews the complex array of barriers to cardiac rehabilitation, with a focus on those factors that are unique to women. The Healthcare Utilization Model is used as a theoretical framework to categorize these barriers into environmental, physician, and patient level categories. These barriers, although challenging for both patients and healthcare professionals, provide opportunities for change. Actionable evidence-based recommendations for healthcare professionals include making changes in health policy, using proven performance improvement methodologies to increase referral and enrollment, using interdisciplinary models of communication, and enhancing cardiac rehabilitation program attributes reflective of women's preferences and needs.