BACKGROUND: Falls from heights remain the most common cause of workplace fatalities among residential construction workers in the United States. METHODS: This paper examines patterns and trends of fall fatalities in U.S. residential construction between 2003 and 2010 by analyzing two large national datasets. RESULTS: Almost half of the fatalities in residential construction were from falls. In the residential roofing industry, 80% of fatalities were from falls. In addition, about one-third of fatal falls in residential construction were among self-employed workers. Workers who were older than 55 years, were Hispanic foreign-born, or employed in small establishments (1-10 employees) also had higher proportions of fatal falls in residential construction compared to those in nonresidential construction. CONCLUSIONS: The findings suggest that fall safety within the residential construction industry lags behind commercial construction and industrial settings. Fall prevention in residential construction should be enhanced to better protect construction workers in this sector.