There is a considerable body of literature, particularly epidemiological and conceptual papers, about substance abuse in rural areas, showing that growing up in a rural environment today affords little protection against susceptibility to substance abuse or its attendant health and social consequences. In the early 1990s, the Center for Substance Abuse Treatment (CSAT) and the National Rural Institute of Alcohol and Drug Abuse (NRIADA) began sponsoring an excellence award to disseminate innovative approaches for combating substance abuse in rural settings. The journal Drugs in Society devoted a special issue to the problem, including a review by Leukefeld, Clayton, and Myers (1992) that summarized the existing knowledge about rural substance abuse treatment. More recently, the National Institute on Drug Abuse (NIDA) released an extensive monograph on the topic (Robertson, Sloboda, Boyd, Beatty, & Kozel, 1997).This chapter reviews epidemiological data on drinking and substantive use of illicit drugs by rural residents. The emerging context for intervention and service delivery is discussed, with an emphasis on integrated care. Assessment and evidence-based treatments are described, as are special populations. Recommendations for providers, policymakers, and research are offered.Definitions and characteristics of rural environments are presented in this volume and elsewhere (Bushy, 1994;Conger, 1997b;Weinert & Long, 1990). Conger (1997a) asserted that social control processes and community networks may vary with population density. Declining economic opportunities and rural poverty could undermine family structure and processes that protect youth from drug involvement (Sloboda, Rosenquist, & Howard, 1997). Robertson and Donnermeyer (1998) found that adult drug users were less likely to be married, had less income, and were more likely to be unemployed. Risk factors may be similar across the rural-urban continuum (Donnermeyer, 1992) but may vary for small towns, which are likely to be individually more homogeneous (Oetting, Edwards, Kelly, & Beauvais, 1997).The same difficulties (e.g., access, acceptability, isolation, rural conservatism) that affect the delivery of general health care in rural areas apply to substance abuse treatment (Conger, 1997b). It is now possible examine the benefits