This document addresses the opioid crisis, and, specifically, the unique challenges that are being faced by rural communities across the United States, including lack of treatment, housing, and transportation options. It presents data from the Rural Responses to the Opioid Epidemic (PROE) project, which was developed to address the substance use crisis in rural America and builds on rural communities’ unique strengths. The project supports 21 rural sites to bring together local public safety, public health, and behavioral health stakeholders in order to address substance use disorder (SUD) and overdoses within the stakeholders’ communities. This report examines the impacts of the work completed by PROE sites, highlighting their accomplishments, providing site summaries that show the impact of PROE funding and activities for rural communities and individuals dealing with the SUD crisis.