Hospitalizations and deaths due to opioid overdose have increased over the last decades. We used data from the National Inpatient Sample and the American Community Survey to describe trends in hospitalization rates for opioid overdose among rural residents compared with urban residents in the United States from 2007 to 2014. Hospitalization rates for heroin overdose increased in all years and were higher in urban residents compared with rural residents (5.5 per 100,000 in large urban populations vs 2.1 per 100,000 in rural populations in 2014). In contrast, hospitalization rates for prescription opioid overdose were 20% to 30% higher in rural populations compared with large urban populations between 2007 and 2012, before declining in rural populations in 2013 and 2014. The proportion of rural patients admitted for overdose who are cared for in urban hospitals increased from 23.1% in 2007 to 41.2% in 2014. These trends are clinically relevant as rural patients and urban patients may have different discharge needs.