She met businessman James Earl Carter and married him immediately after her graduation. The couple had four children: Jimmy (born in 1924), Gloria (1926–1990), Ruth (1929–1983), and Billy (1937–1988). While she theoretically retired from nursing in 1925, in reality she worked as what was then called a nurse practitioner both for the hundreds of employees back in her husband's businesses and for members of the Plains community. While a religious woman, Carter was not a regular attender of church services. After some sisters at the local church organized a mission trip to Africa, Carter became upset saying that there was plenty to be done in the US before traveling to another country. She coordinated her own Bible study at home on Sunday mornings while the rest of the family attended church.