Many students in rural U.S. schools are experiencing trauma and adverse childhood experiences due to circumstances relating to the opioid crisis. A moral imperative presents itself to school principals and other educational leaders to make context-specific decisions that are responsive to the trauma experienced by the students in their schools. This case study investigated the lived experiences of 12 rural school leaders from five school districts in Appalachian Ohio. Specifically, we examined their experiences with?opioid-related issues in their schools. This research recognizes the needs of school principals and assistant principals as they lead in a time of challenges and chaos due to opioid-related issues. As a focus of our analysis, which prioritizes a crisis leadership approach, we examined principals engaging in a practice of bricolage to "make do" in the midst of the ongoing crisis. This collective case study presents critical cases through in vivo themes that emerged from the data: 1) "No Longer Surprised," 2) "Going Down the Rabbit Hole," 3) "I Don't Know What Could Prepare You," and 4) "We Made Decisions We Thought Would Help." The implications consider ways in which practitioners, preparation programs, and policy makers can reconsider professional preparation, ongoing trainings, and funding models to integrate opioid awareness and crisis response capacity.