In the past decades, one in five rural U.S. counties have increasingly seen people die younger than expected, while many urban counties have seen improvements in that area, CNBC reports. Causes of premature death are often preventable. In this case, the spike has coincided with a drug epidemic that has resulted in a larger number of overdoses throughout the country.

Since 2002, fatal overdoses have gone up by 79% with a 200% increase in deaths related to opioids, such as heroin and prescription painkillers. According to the 2016 County Health Rankings report, fatal drug overdoses are most common in northern Appalachia and in certain Western and Southwestern areas, and least common in the Northeast.

On average, 13 per 100,000 people die of drug overdoses in the U.S.; that number climbs as high as 85 per 100,000 in some rural areas where naloxone, a drug that reverses the effects of opioids, is less accessible. If somebody has overdosed “there isn’t always time to get them to a hospital,” Bridget Catlin, director of the County Health Rankings, told CNBC. “That’s why it’s so important that first responders carry [naloxone] with them.”

Drugs aren’t the only health risk to rural county residents. They also have higher rates of smoking, obesity, child poverty, and teen births as well as struggle with access to jobs, health care, and physical activity.