The Rural Responses to the Opioid Epidemic (RROE) project, co-funded by the Bureau of Justice Assistance, the Centers for Disease Control and Prevention, and the State Justice Institute, was developed to address the substance use crisis in rural America and build upon rural communities’ unique strengths by supporting 21 rural sites across the country to bring together local public safety, public health, and behavioral health stakeholders to address substance use disorder and overdoses within their communities. This report details the wide-ranging impacts the RROE sites' work had on their communities, from improving outcomes for individual residents to making more effective use of public safety and health systems.