Policies intended to reduce the harm caused by substance abuse in the United States have been shown to have positive results in reducing the rates of communicable diseases and overdose related deaths in communities that have chosen to implement such policies. Specifically, syringe exchange programs have been shown to reduce the rates of HIV/AIDS in cities and counties that have them. Currently, most syringe exchange programs are in large cities leaving hard hit rural communities to suffer with the effects of HIV/AIDS with fewer resources than their urban counterparts. When syringe exchanges are in rural areas, a combination of proximity to the programs, stigmatization, policing policy, and other environmental factors reduce the ability for syringe exchange programs to operate at their maximum level of effectiveness. It is important to understand exactly what the disparity in efficacy in syringe exchange programs in urban and rural environments is, and what causes it so that local, state, and federal policymakers can work to tailor programs and policies to rural communities. This study uses fixed effects and interactive models to analyze time series panel data to test the effect of syringe exchanges in urban and rural contexts. The data was collected primarily from census data, but an independent measure of social capital is also used, as well as information from nonprofit groups such as the Foundation for Aids Research, and the North American Syringe Exchange network. The fixed effects model control for homogeneity in counties over time, and additional control variables include if a county is in a Medicaid expansion state, health insurance rates, and the presence of a syringe exchange program in a county. Using this data, I find that as rurality increases, syringe exchange programs are less effective, per the hypothesis, alongside several other findings. This research suggests that governments would be wise to both increase syringe exchange program coverage, especially in rural areas, and implement mobile syringe fleets.