This study describes differences in health risk behaviors among 2,017 adolescents attending rural, suburban, and urban school districts in upstate New York. Differences in risk behaviors regarding use of tobacco, alcohol, and illegal substances; sexual activity; and carrying weapons were analyzed. A consistent pattern emerged from the analysis of the data, with rural students at most risk. The findings reinforce the need to focus on the relationship between residence and health risk behaviors, so that intervention programs specific to the needs of rural, suburban, and urban adolescents can be developed.