The effects of the opioid epidemic are particularly pronounced in rural areas, where opioid prescribing and drug overdose deaths are more frequent than in urban areas. Little is known about the opioid prescribing patterns of nurse practitioners (NPs) compared to primary care physicians – and how prescribing patterns differ for rural versus urban practices. This policy brief presents findings from a comparison of 2017 opioid prescribing rates among physicians and NPs within rural and urban primary care practices using a novel database of all-payer healthcare claims and e-prescribing data.