This chapter deals with an anecdote about drug use in a rural region of Ohio, and then address the issue more systematically within the context of an ever-changing, and many would say ever-declining, rural America. Most persistent-poverty rural counties long ago flipped both to voting for conservative candidates and developing a culture of drug use, and a critical view accounting for long-term structural change would acknowledge those factors. The story of drugs today is not about an epidemic, but about a concomitant progression of drugs abuse associated with economic, social, and cultural change. The abuse of specific drugs today ebbs and flows with supply, demand, price, and enforcement efforts. Networks are close-knit and often family-based, and even though the source of a drug may be from outside the community, the distributors are mostly locals. The development and continuously changing nature of a drug-using culture in rural America is normal–that is, embedded deeply as one part of its social organization.