Individual perception of risk has consistently been considered an important determinant of hurricane evacuation in published studies and reviews. Adequate risk assessment is informed by environmental and social cues, as well as evacuation intentions and past disaster experience. This cross-sectional study measured perceived flood risk of 570 residents of three coastal North Carolina counties, compared their perception with actual risk determined by updated flood plain maps, and determined if either was associated with evacuation from Hurricane Isabel in 2003. Census blocks were stratified by flood zone and 30 census blocks were randomly selected from each flood zone. Seven interviews were conducted at random locations within selected blocks. Bivariate and multivariable analyses were conducted to produce crude and adjusted risk differences. Neither the designated flood zone of the parcel where the home was located nor the residents' perceived flood risk was associated with evacuation from Hurricane Isabel in the bivariate analysis. In the multivariable analysis, intention to evacuate and home type were important confounders of the association between actual risk and evacuation. The belief that one is at high risk of property damage or injury is important in evacuation decision making. However, in this study, while coastal residents' perceived risk of flooding was correlated with their actual flood risk, neither was associated with evacuation. These findings provide important opportunities for education and intervention by policymakers and authorities to improve hurricane evacuation rates and raise flood risk awareness.