Prior research demonstrates that children in the child welfare system are given psychotropic medication at rates approximately three times higher than children and adolescents in the general population. Using data from the second National Survey of Child and Adolescent Well-Being, authors Wendy Walsh and Marybeth Mattingly report that among children age 4 and older with a report of maltreatment, rates of psychotropic medication use are significantly higher in rural (20 percent) than urban areas (13 percent). Children age 4 and older with a maltreatment report in rural areas were significantly more likely to take more than one medication than children in urban areas. The significantly higher rates of psychotropic medication use among children in rural areas and the significantly higher rates of taking multiple medications point to the need among child welfare professionals in rural areas to closely monitor use. The results of the current analysis indicate that more information is needed about the complex decision-making process regarding medication use. This includes a need to better understand how pediatric clinicians make decisions, and the impact of community norms on medication use.