Assesses the prevalence of, and recent trends in, alcohol use among adults 18 years and older in rural areas of the United States. It uses a random digit telephone survey method to gather information on alcohol use among adults in 49 states and the District of Columbia that participated in the Behavioral Risk Factor Surveillance System. The paper finds that heavy drinking was highest and increasing in urban areas, but that binge drinking was greater in rural areas. It recommends tailoring interventions specifically to meet the needs of rural residents.