OBJECTIVES: To capture the trends in opioid prescribing and to determine whether rural residency impacts opioid prescribing patterns. METHODS: We used the National Ambulatory Medical Care Survey (NAMCS) data available for the years 2006-2010. The NAMCS data is a nationally representative annual survey of the provision and utilization of outpatient medical care services in the US. Main outcome measure was opioid drug prescribed. Survey weighted logistic regression models were fit to determine factors influencing opioid prescribing. RESULTS: Opioid prescriptions increased from 10% in 2006 to 12% in 2010. There was an increasing trend in rural opioid prescribing (11% in 2006, 12% in 2007, 14% in 2008, 15% in 2009 and 2010) as compared with urban location (10% from 2006-2008, 12% in 2009 and 11% in 2010). Primary care physicians and medical professionals were more likely to prescribe opioids (13% in 2006, 12% in 2007, 16% in 2008, 17% in 2009 and 14% in 2010) as compared with surgeons (6%, 11%, 10%, 10%, 14% respectively). Multivariate analyses revealed that over the years, younger patients (35-49 and 50-64), who did not have a cancer diagnosis, and were insured by Medicare or other type of insurance were more likely to get opioid prescription, while patients seen by surgeons were less likely to get opioids.  CONCLUSIONS: Our study poses significant implications for healthcare professionals and policy makers. Our study not only demonstrated that rural residents were more likely to be prescribed opioids but it showed an upward trend in rural opioid prescribing which was significantly different from urban locations. Increased prescribing of opioids, has led to a growing problem of prescription drug abuse especially among rural residents. Further research is warranted to study the extent of over prescribing and abuse in rural communities.