This study seeks to identify how rural adolescents make health decisions and utilize communication strategies to resist influence attempts in offers of alcohol, tobacco, and other drugs (ATOD). Semi-structured interviews were conducted with 113 adolescents from rural school districts to solicit information on ATOD norms, past ATOD experiences, and substance offer-response episodes. Rural youths' resistance strategies were similar to previous findings with urban adolescents--refuse, explain, avoid, and leave (the REAL typology)--while unique features of these strategies were identified including the importance of personal narratives, the articulation of a non-user identity, and being "accountable" to self and others. (Contains 2 figures.)