 This study found that rural primary care practices face unique challenges when trying to implement evidence-based programs to manage opioid use. These include competing demands on clinicians and staff, a culture of clinically and autonomy, inadequate data systems, and a lack of patient resources in rural areas. However, there were also some positive factors such as a desire to help patients and their communities, external pressure to make changes in opioid management, and support from external sources. This article was authored by Michael L. Porchman, Brooke Ike, Catherine P. Osterhage and others.