Police are appealing for information after the collision happened on the A4110 near Aymestrey, between Ludlow and Leominster, on Wednesday morning .
The crash happened at around 9.30am and involved a blue Honda Civic and a yellow Audi.
One of the drivers, a 79-year-old man from Aymestrey, was killed and two women from the second car were seriously injured.
An air ambulance was sent to the scene along with two land ambulances, a paramedic officer, BASICS doctor, police officers and firefighters.
A West Midlands Ambulance Service spokesman said: “On arrival we discovered three patients. One of them, a man, who was the driver of one of the cars, was in a critical condition.
“Ambulance staff immediately began administering advanced life support but sadly, despite their best efforts, it became apparent nothing could be done to save him and he was confirmed dead at the scene.
“Two women, one of whom was a driver and one who was a passenger, were treated for serious injuries and both taken to Hereford County Hospital by land ambulance.”
No other injuries were reported.
The road remained closed on Wednesday afternoon as police examined the scene.
Officers have urged anyone who saw the cars being driven or captured them on dash-cam footage to get in touch.
Anyone with any information is asked to visit the police website quoting reference 129 of November 17.