The PReventing Opioid Misuse In the SouthEast (PROMISE) Initiative team conducted a needs assessment to explore Mississippians' perceptions of the emerging issue of opioid misuse and to identify ways Extension professionals can assist in opioid misuse prevention. In this article, we describe the assessment process that included a series of community forums and a statewide electronic survey. Additionally, we explain how we used the assessment findings to define participants' involvement in opioid misuse prevention and to develop messages to be disseminated by Extension professionals. Information presented here may be of use to Extension personnel in other states interested in engaging in opioid misuse prevention.