Aim: To estimate the prevalence of and recent trends in alcohol use among U.S. adults in rural areas. Methods: A telephone survey of adults aged 18 years or older residing in states participating in the Behavioral Risk Factor Surveillance System (BRFSS), in the years 1995/1997 and 1999/2001. Results: Urban counties led rural counties for moderate and heavy drinking in 1999/2001, and also saw the largest increases in heavy drinking between 1995/1997 and 1999/2001. Binge drinking was nearly as high in remote rural counties with a large town as in urban counties, and increased the most for remote rural counties with a large town. Urban whites were more likely than any other racial/ethnic group to report moderate or heavy drinking, while American Indians in remote rural counties with a large town were the most likely to report binge drinking. Significant increases in heavy and binge drinking were highest for rural residents in the Northeast and Midwest and lowest in the South Census region. Conclusions: Heavy drinking was highest and increased the most in urban counties; however, binge drinking increased the most in remote rural counties with a large town, and heavy and binge drinking increased for rural counties of all types. Funded by HRSA’s ORHP.