Substance abuse is a pervasive problem across the globe, impacting the health and well-being of those who abuse alcohol and substances and their family members. While this problem affects individuals across numerous demographic factors (e.g., gender, race and ethnicity, or socioeconomic status), there are different patterns and types of substance abuse in urban and rural areas. This chapter focuses on the unique aspects of alcohol and substance abuse in rural, frontier, and remote areas and examines health disparities and racial and ethnic differences in substance abuse. In addition, this chapter discusses special challenges in providing prevention and intervention services to the people who live in rural and remote areas of the world and the roles of psychologists in providing this care.