The purpose of this brief was to compare the prevalence of key risky substance use behaviors (tobacco, alcohol, and illicit drug use) among adults residing in nonmetropolitan (rural) and metropolitan (urban) counties. Combined 2017-2018 data was used from the National Survey on Drug Use and Health (NSDUH) to determine the prevalence of risky substance use and compare the adult rural and urban populations. Significant differences were found in tobacco use, alcohol use, and some subcategories of illicit drugs.