Substance abuse counselors are vulnerable to burnout, which has negative repercussions for the counselor, employing organization, and clients. However, little is known about differences in counselor burnout from the counselors' perspective in rural versus urban treatment centers. In 2008, focus group data from 28 rural and urban counselors in a southern state were analyzed, revealing three burnout themes across all counselors: causes, consequences, and prevention. However, there were various differences between rural and urban counselors in subthemes, with only rural counselors citing office politics and low occupational prestige as causes of burnout. Only urban counselors reported responses endorsing the subthemes of role reversal, clients trying to choose their counselors, and changing jobs as consequences of burnout. All counselors cited coworker support, clinical supervision, and self-care as important strategies for managing burnout. In sum, context clearly matters as rural counselors cited more causes of burnout; yet, the implications of burnout are universal in that they often lead to poor quality clinical care. There is a continued need for greater understanding of addiction as a disease, which would reduce stigma, especially in rural areas, as well as increase the prestige and earning potential of the substance abuse counseling occupation.