Tobacco use is a leading preventable cause of disease in the U.S. Rural youth have higher initiation rates and greater risk for tobacco use. Due to high prevalence patterns, it is important to examine the effectiveness of antitobacco messaging among rural youth populations. This study contributes to the paucity of studies investigating the effectiveness of antitobacco/nicotine use messaging on rural youth by highlighting high school students' perspectives on antitobacco/nicotine advertisements with a sample of high school students in rural Montana. This study utilized focus groups with Montana high school students to collect qualitative data on their perceptions of the content and delivery of antitobacco messages. Thematic coding was used to analyze transcripts created from the focus groups. The aim was to identify effective preventative strategies for rural populations by analyzing their reactions to six prevention advertisements, with the aim of identifying elements in advertisements that would increase acceptance or lead to rejection of the advertisement by rural youth. Focus groups revealed that antitobacco messages that employed compelling storytelling and emotional engagement--particularly through fear and disgust--were the most effective. Advertisements that addressed mental health issues, on the other hand, were criticized for potentially minimizing the significance of mental health conditions or overstating nicotine's effect. Portrayals of rural identity in ads were often seen as inauthentic or oversimplified, failing to connect with the youth's real experiences and interests. Findings suggest that antitobacco campaigns accurately represent rural youth using authentic, fact-based narratives for all elements in the prevention messages. Public health and school officials tasked with prevention efforts should integrate these insights to create tailored prevention strategies that resonate with rural youth, improving campaign effectiveness and equity in health outcomes. Based upon this study among rural high school students in Montana, antitobacco campaigns for rural youth must focus on authenticity and relevant messaging to effectively engage and reduce tobacco use among this group.