In the United States, many rural communities are confronted with the dual burden of intimate partner violence (IPV) and the opioid crisis. In the past decade, rural US communities have experienced extremely high rates of opioid use disorder and opioid-related fatalities. At the same time, rural communities continue to experience high rates of IPV and a lack of accessible services. This chapter presents the findings of an interdisciplinary, community-based participatory study of 33 rural Vermont residents who have experienced co-occurring opioid use and IPV and 18 service providers representing a county Coordinated Community Response team. Their experiences richly illustrate the reality of social and geographic isolation, inaccessible social services, and the amplified impact of stigma in small town settings. We demonstrate important challenges for delivering victim services for rural residents with complex, interrelated needs, especially when supporting communities via teleservices, as so many organisations have had to do during the COVID-19 pandemic. We conclude with recommendations for multidisciplinary, inter-agency approaches to reducing barriers to care.