It happened Sunday just after noon, just east of Cabool on Highway 60.
Troopers say a van failed to yield at a crossover, and was broad-sided by a pickup.
The pickup then hit a car.
The driver and passenger of the van died at the scene.
They are Raymond Gochal, 64, and Rose Gochal, 89, both of Mountain Grove.
A 5-year old boy riding in the pickup suffered serious injuries.
He's in a Springfield hospital.
And five other people had moderate injuries.