Those four areas top this year's list of the states with the worst drivers, according to a survey performed by GMAC Insurance.
"It's discouraging to see that overall average test scores are lower than last year," said Wade Bontrager, a senior vice president for GMAC Insurance, which ranked drivers.
GMAC for the past six years has surveyed roughly 5,000 people across the country with 20 test questions taken from various state driving tests. It turns out than many Americans don't really know what it means when there is a solid yellow line on one side of the center line or what type of lights to use when driving in the fog. (No passing and use your low beams.)
If the numbers from the GMAC survey held true for the entire U.S. population, it would mean that one in five licensed drivers -- roughly 38 million Americans -- would not pass a written drivers exam if taken today.
The overall scores fell from 76.6 percent last year to 76.2 percent this year. Eighty-five percent could not identify the correct action to take when approaching a steady yellow traffic light (stop if it is safe to do so) and many remained confused by safe following distances (3 seconds.)
And in case you were wondering, the best drivers in the country are in Kansas, Oregon, South Dakota and Minnesota.
The goal of the annual test -- besides some free publicity for GMAC -- is to help educate drivers. Bontrager said people need to remember the rules of the road and that educated drivers are safer drivers.
"American drivers need to make safety a top priority and be aware of the rules of the road at all times," he said. "The National Drivers Test allows everyone to brush up on their driving knowledge with a brief refresher course."
As an insurance company, GMAC sees the results every day of what happens when people don't know the rules of the road, Bontrager added.
Overall, the Northeast had the lowest average test scores at 74.9 percent, and the highest failure rate at 25.1 percent. The Midwest had the highest average test scores at 77.5 percent and the lowest failure rates at 11.9 percent. (Test-takers need to score at least 70 percent on the test to pass.)
So why are some regions better drivers than others?
Bontrager said it might because people that drive in very congested areas lose sight of the rules of the road. But that's just speculation.
Another theory: people in states with large metropolitan areas tend to take public transit more often and lose some of their driving skills.
"We certainly wouldn't suggest that people avoid any place [because of the test]. You ought to be a defensive driver no matter where you are, follow the rules of the road and understand that not everybody out there knows them as well as you do," Bontrager told ABC News when last year's test results came out. "Whether I'm driving in New York or Des Moines, I want to be a defensive driver. Maybe I can breathe a little easier in Des Moines or Idaho than I can in a congested area. But it doesn't change how you should drive."
The most frequently missed question, year after year, is the proper safe distance to follow another car on the road.