Rural America—representing 97% of America’s land mass and defined by small towns and sparsely populated areas—is home to one-fifth of all Americans.1 In rural America, combustible cigarette smoking is a major challenge to health equity. Rural Americans start smoking at a younger age than their urban counterparts,2 and, in 2020, the smoking prevalence in rural areas was estimated at nearly 19.2% compared to 14.4% in urban areas.3