This chapter provides background on rural culture and the influence it has on the implementation of trauma-informed care. The cultural characteristics create additional obstacles to schools that are working to mitigate the adverse experiences that have debilitated many students. The poverty and drug use that families face has created a generation of children who struggle with chronic stress from the adverse childhood experiences that occur in their lives. This impedes all academic and many functional areas. Without appropriate education, teachers are often unable to reach students and misunderstand why students with multiple adverse experiences display behaviors. The authors share strategies to mitigate the impact of the adversities.