Rural areas were defined as counties that were not part of metropolitan statistical areas. According to the 2002 NSDUH, an estimated 3.8 million persons ages 12 to 20 lived in rural areas. In 2002, youths ages 12 to 17 who lived in rural areas reported higher rates of past-month and binge alcohol use than nonrural youths; among those ages 18 to 20, rural residents reported lower rates of past-month use than nonrural persons. This pattern for 18 to 20 year-olds was partially due to a higher percentage of college students living in nonrural areas. The rates of binge drinking were similar between rural and nonrural persons ages 18 to 20. Among youths who received grades of A or B in their last semester's school work, rural youths reported higher rates of past-month and binge alcohol use than nonrural youths. Youths ages 12 to 17 who lived in rural areas were less likely to perceive great risk from having four or five alcoholic drinks nearly every day than those who lived in nonrural areas. Youths in rural areas were less likely than nonrural youths to strongly disapprove of someone their own age having one or more drinks nearly every day or to report that their parents would strongly disapprove if he/she were to have one or more drinks nearly every day. 3 figures and 7 notes