Purpose: This study examines the local and institutional factors that shape how educators and educational leaders in western Pennsylvania have understood and responded to rapid growth in opioid misuse and drug overdose within their communities. We examine how educational leaders and educators in two rural school districts in western Pennsylvania made sense of growing opioid misuse as not only a social problem but also a local problem, and how that framing in turn shaped their community and school response. Research Methods/Approach: We analyze data gathered from interviews and fieldwork conducted in two rural school districts in Pennsylvania in 2017-18 experiencing high levels of opioid misuse and drug overdose. Data were drawn from interviews with 36 educators and educational leaders, as well as notes from roughly 60 hours of participant observation in each district at school board meetings, local action group meetings, and community events. Findings: We find that community and institutional forces restricted coherent and meaningful school responses. School district leaders understood growing opioid misuse as emerging both external to and in contradiction with local rural community values and identity. Educators further cited testing assessment pressures and lack of educator training as institutional factors limiting school and educator responses to the mounting opioid problem. Implications: Despite a precedent for schools assuming a variety of health and wellness functions for students and families, and the severity of opioid misuse as a government-defined statewide emergency, coherent school response to opioid addiction is often stymied by a number of social, cultural, and institutional constraints.