Substance use is a significant public health issue in rural communities. In particular, the opioid epidemic continues to have a devastating impact in rural areas disproportionately affected by a lack of infrastructure to provide treatment for substance and opioid use disorders. Critical Access Hospitals (CAHs), often the hubs of local systems of care, can play an important role in addressing substance use disorders. To develop a coordinated response to community substance use issues, CAHs must identify and prioritize local needs, mobilize local resources and partnerships, build local capacity, and screen for substance use among their patients. These activities provide a foundation upon which CAHs and their community partners can address identified local needs by selecting and implementing initiatives to minimize the onset of substance use and related harms (prevention), treat substance use disorders, and help individuals reclaim their lives (recovery). This webinar makes the case for why CAHs should address opioid and substance use, provides a framework to support CAHs in doing so, and describes examples of substance use activities undertaken by CAHs to substantiate the framework.