Substance abuse is a significant problem among South Dakota youth. Other than marijuana, prescription drugs and over the counter medications account for the most commonly abused drugs by high school seniors. Physicians play a significant role in future substance prevention efforts. Adolescents and research related to rural communities are areas of discussion. Community prevention coalitions are a commonly utilized mechanism for supporting community-based substance prevention efforts. Access to community coalitions, relevant student data, evidence-based practices, school based interventions and the use of technology are essential areas of prevention efforts in South Dakota and other rural communities in the U.S. The authors discuss child and adolescent substance abuse prevention, especially as it relates to physicians and families in rural populations. Effective prevention efforts in rural communities must integrate alliances with physicians, community coalitions and evidence-based school prevention programs with existing social media. It is crucial to have culturally specific programming within the context of prevention, especially for the Native American youth in South Dakota. This paper recommends the use of community coalitions and computer technologies to reduce the costs associated with other outpatient and inpatient substance abuse programs.