Overview of Key Findings • Rural counties have higher per capita numbers of substance use disorder treatment facilities than urban counties on average, but also greater variability and large pockets of unmet need. • The highest proportions of residents living in counties without any treatment facilities are concentrated in rural areas within the Midwestern and Southern United States. • Rural and urban treatment facilities offer medications for opioid use disorder (MOUD) at similar rates, with inpatient facilities most likely to provide MOUD, followed by residential and outpatient settings.