Truancy is a considerable problem among adolescents. Considering the historical emphasis on studying truancy in urban regions, a concerted effort is needed to extend this research into rural areas to examine cultural generalizability of findings. The purpose of this study was to assess variables associated with truancy in a rural sample (N = 367) of students attending high school in a southern rural region of the Appalachian Mountains. The primary objective was to assess the relative predictive strength of the following variables: academic performance, religiosity, environmental factors (family structure, parental education, and adolescent perceptions of family functioning), internalizing problems (anxiety, depression, thought problems, attentional problems), externalizing problems (substance use and rule-breaking behaviors), and prosocial overt behaviors (participation in school and leadership activities). Regression analysis indicated that truancy was significantly associated with poor school performance, increased depression, social problems, having a less educated mother, a less structured home environment, higher grade, and decreased participation in school sports. EDITORS' STRATEGIC IMPLICATIONS: These findings are critical for the understanding of truancy in rural areas, and they highlight contextual factors that must be identified and addressed through systematic prevention programs targeting adolescents at risk for truancy.