Ellenville Regional Hospital (ERH) is a critical access hospital serving the western communities in Ulster County, New York, and is one of only two hospitals in the county. ERH’s RROE project covered rural areas of Ulster County and the entirety of Columbia and Greene Counties, New York, with a total population of 257,128 residents. ERH worked to develop and expand the three counties’ approaches to the prevention of opioid use and overdose and brought together large, diverse, collaborative teams to take three separate approaches to this work. ERH and its partners worked together to assist community agencies, with a focus on law enforcement, in utilizing ODMAP and to educate those agencies on the importance of proper and consistent data collection. ERH also developed a high-risk mitigation team (HRMT), a model of care coordination that brings agencies from many sectors together to do live case conferences on shared clients to help fill cracks in the system of care, which led to more than 100 individuals signing up to work with one of the peer agencies participating on the HRMT. Lastly, ERH developed and began implementation on an OFR team in Ulster County and a joint team for Columbia and Greene Counties.