The accident happened around 2 p.m. on Highway 24 near Pumpkintown Road.
Authorities said 65-year-old Stella Watson was going west on Highway 24 when she crossed the centerline and clipped the back of a eastbound tractor trailer.
Watson's two grandchildren were airlifted to UNC Hospitals with serious injuries. Watson was also seriously injured and taken to Cape Fear Valley Medical Center in Fayetteville, and then later to UNC Hospitals.
A woman riding in the tractor trailer suffered minor injuries, but the driver was not hurt.