The salinization of freshwater-dependent coastal ecosystems precedes inundation by sea level rise. This type of saltwater intrusion places communities, ecosystems, and infrastructure at substantial risk. Risk perceptions of local residents are an indicator to gauge public support for climate change adaptation planning. Here, we document residential perspectives on the present and future threats posed by saltwater intrusion in a rural, low-lying region in coastal North Carolina, and we compare the spatial distribution of survey responses to physical landscape variables such as distance to coastline, artificial drainage density, elevation, saltwater intrusion vulnerability, and actual salinity measured during a synoptic field survey. We evaluate and discuss the degree of alignment or misalignment between risk perceptions and metrics of exposure to saltwater intrusion. Risk perceptions align well with the physical landscape characteristics, as residents with greater exposure to saltwater intrusion, including those living on low-lying land with high concentrations of artificial drainages, perceive greater risk than people living in low-exposure areas. Uncertainty about threats of saltwater intrusion is greatest among those living at higher elevations, whose properties and communities are less likely to be exposed to high salinity. As rising sea levels, drought, and coastal storms increase the likelihood of saltwater intrusion in coastal regions, integrated assessments of risk perceptions and physical exposure are critical for developing outreach activities and planning adaptation measures.