Data indicated that rural MA production in Arkansas and Kentucky surpassed interstate imports as the primary local sources of MA over the last decade. Patterns of MA production were similar across the two States, although MA production became common earlier in Arkansas. The Birch production method was the most frequently identified method of production in both areas. Factors impacting the rise of rural MA production in Arkansas and Kentucky included personal desire for MA by regular users, the availability of ingredients, perceived ease of manufacture, and the sharing of Birch cooking recipes. Participants described how they gained access to restricted ingredients, such as anhydrous ammonia and pseudoephedrine pills. None of the participants indicated involvement in criminal gangs or organized drug trafficking. MA was produced mainly for personal use, gift giving, barter with friends and acquaintances, and some local sales. The findings suggest that the policies and programs used to combat MA production and distribution in urban areas may not be effective in rural areas where the patterns of MA production and distribution may be different. Educational programming may also be more effective when it is tailored to particular populations. Participants were 36 active MA users and 1 former user, including 10 MA “cookers,” recruited through a larger natural history study of rural stimulant users and health services needs in rural eastern Arkansas and rural western Kentucky. A semi-structured interview was used to gather information about MA production and distribution. Interview transcripts were coded according to emerging themes and patterns. Future research should focus on how local acquisition and distribution of MA ingredients and patterns of MA cooking may change in response to changing legislation designed to restrict access to MA ingredients. Tables, references