Carter was born Bessie Lillian Gordy on August 15, 1898 in Richland, Georgia, to James Jackson Gordy (1863–1948) and Mary Ida Nicholson Gordy (1871–1951). She was the niece of Berry Gordy I, who was the paternal half-brother of James Jackson Gordy and the grandfather of Motown Records founder Berry Gordy. She volunteered to serve as a nurse with the U.S. Army in 1917 but the program was cancelled. Instead, she worked for the US Post Office at Richland before moving to Plains, Georgia in 1920 where she was accepted as a trainee at the Wise Sanitarium before completing her nursing degree at the Grady Memorial Hospital School of Nursing in Atlanta, Georgia in 1923. Lillian's family initially disapproved of her choice of a career in nursing, but she continued her training and became very successful, earning the respect of both the black and white communities. "Miss Lillian", as she was often known, allowed black people to enter her home through the front door, rather than through the back door as was the social norm, and would often have them in her living room for casual conversation just as she would a white neighbor. These conversations would even continue after her husband Earl was to arrive home expecting the guests to depart.