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Primary health care providers are often some of the only helping professionals in rural communities, where community resources to treat substance abuse or shelter survivors of intimate partner violence (IPV) are scarce. This article reports on qualitative findings from a larger study examining the responsiveness of rural health care providers to IPV and substance use. Findings from 27 interviews revealed that providers rarely assessed for IPV or substance use, and patients with a history of substance abuse described their health care encounters in negative terms. Providers and patients differed in their descriptions of typical health care encounters involving women concurrently experiencing IPV and substance abuse, but agreed on several basic points, among them the severity of IPV when substances were involved and the unfortunate shortage of social services to address violence and addiction. The article concludes with suggestions for future research on addressing IPV and substance use in primary care settings and the implications for social work. [ABSTRACT FROM PUBLISHER]