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This study examines the lived experiences of rural Appalachian superintendents responding to the impact of opioids on students and schools. We ask: How do rural superintendents perceive and make meaning of the impact of opioids on their districts? Understandably, the pandemic diverted many resources to offset the impact of the virus in schools. However, opioids continued to be a major concern for many. In this inquiry, we employ an interpretative phenomenological approach (IPA), using semi-structured interviews to prompt leaders to share their perceptions about their lived experiences with the opioid crisis. Findings reveal key themes: trauma-informed care training, coordinating to mobilize services for students experiencing adverse childhood experiences due to opioid-related issues, expectations for principals, and external community leadership.