This Article seeks to raise the visibility of the roughly twenty percent of the U.S. population who live in rural places--an often forgotten fifth--in relation to the particular challenges presented by adolescent substance abuse. Despite popular notions that substance abuse is essentially an urban phenomenon, recent data demonstrate that it is also a significant problem in rural America. Rural youth now abuse most substances, including alcohol and tobacco, at higher rates and at younger ages than their urban peers. The Article assesses the social, economic and spatial milieu in which rural adolescent substance abuse has burgeoned. Features of some rural communities, such as a tolerance for youth and lenient and informal law enforcement responses, appear to benefit youth. Indeed, these are consistent with juvenile justice trends, such as diversion programs. Yet other characteristics of rural communities, such as limited social service and healthcare infrastructures, undermine the efficacy of such programs.