BACKGROUND: Rural communities are disproportionately affected by substance use disorder (SUD) and public stigma impedes access to and utilization of treatment and support services. METHODS: This study compares data from a 2020 study conducted in rural Ohio (N = 173) with results from a recent study conducted in South Dakota (N = 41) on publicly-held stigmatizing views of SUD. South Dakota participants were recruited at several public events across the state via convenience sampling between August 2022-February 2023 to complete a survey. Data from responses to 19 stigma-related questions were merged with the associated data from the 2020 Ohio study and a comparative analysis was performed using Fisher's exact and Chi square tests. RESULTS: The data shows that respondents in South Dakota, when compared to respondents in Ohio, are more likely to believe addiction is an illness (SD = 86.5%, OH = 48.5%, p < 0.001). The belief in SUD as an illness aligns with reduced stigmatizing beliefs, as indicated by respondents in SD showing lower stigmatizing ideologies and higher support for naloxone and harm reduction services, when compared to Ohio respondents. In both studies, the belief that SUD is an illness was associated with a reduction in other stigmatizing beliefs. CONCLUSIONS: These results can be used to inform more focused anti-stigma efforts. As more people adopt fewer stigmatizing views on SUD in rural areas, more people with SUD may be supported to seek treatment and recovery services.