This paper highlights opioid misuse behavior among rural or nonmetro residents using micro data from the recently released 2018 NSDUH. Compared to the urban population, rural residents are 87% more likely to be prescribed opioids, and the overdose death rate driven mostly by prescription opioids has been trending higher in nonmetro regions since 2004. To tackle the opioid epidemic, communities need an accurate assessment of what is happening on the ground, assessing what intervention is working, and what is not. This report describes the happenings on the ground. A multi-variable, contingency table analysis of individual responses to NSDUH reveals that the nonmetro region is home to 1.53 million of opioid misusers of which 52% are either unemployed, not in the labor force, or less than 18 years of age. A person’s employment and health status are the context for the misuse. White-collar, salaried social group misuses opioids the most.