Women from Appalachian regions of the United States face a number of health-related disparities, including mental health and substance misuse. Alcohol misuse is a significant public health concern among women in the United States, associated with numerous adverse consequences for the woman, her unborn children, and any children in her care, yet data on correlates of risky alcohol use is limited among women from Appalachian Ohio. The current study examines the prevalence and predictors of risky alcohol use (e.g., heavy episodic drinking) in 2,349 women from 18 clinics in the Community Awareness Resources and Education I (CARE I) study in Appalachian Ohio. Alcohol use history was collected over the past 30 days. Regression models were employed to identify predictors of heavy episodic drinking. Results indicate that 20% of the current sample reported heavy episodic drinking. Being an emerging adult (18–26 years), single, a current smoker, and reporting a history of 4 or more partners were independently associated with heavy episodic drinking. Self-identifying as Appalachian was not protective or predictive of heavy episodic drinking. Further research identifying risk factors and enhancing protective factors will inform culturally competent preventive efforts, particularly for emerging adult women from Appalachian Ohio at risk for alcohol misuse and associated morbidities.