Findings from recent epidemiological investigations indicate that substance use in rural America has increased to the point where it nearly equals, if not exceeds, the rates found in suburban and urban areas. Although previous research has examined factors that have influenced use patterns, little attention has been devoted to the social and community contextual influences on these drug use trends. Based on a review of the literature, this article's purpose is to discuss distinctive features of rural communities, describe the impact of social and community influences on drug use, and explore implications for future research and interventions. Although rural areas have undergone tremendous economic and social change in the past 20 years, there remain unique social and community factors that serve to mediate alcohol and illicit drug use. In order to reduce drug use in rural areas, prevention and intervention efforts must consider social and environmental influences. Utilization of a multilevel social epidemiological approach could be particularly effective in developing a theoretical framework that best addresses these rising drug trends.