Seat belt use on rural roads is especially important due to the relatively high risk for injury compared to urban areas. In the northern plains, where nearly 90% of travel occurs on rural roads, addressing this issue is particularly critical. A cohort group of 32 states was used to study seat belt use on rural roads. Means tests and regression models were designed to identify influential factors in state-level seat belt use rates as well as individual driver seat belt decisions. Results show state-level seat belt use rates are inversely related to the share of annual miles traveled on rural roads. Higher citation rates are positively related to seat belt use in the case of state-level rates. Fatal crash event analysis shows that higher shares of urban population in the state where the crash occurred increases likelihood for seat belt use. Primary enforcement is associated with a 14% greater probability for seat belt use among cohort drivers. Higher fines also have a significant influence. Cohort drivers were 21% less likely to be belted when fines were $20 or less. This effect is more pronounced in primary states than secondary states. Drivers in those states are 36% less likely to be wearing seat belts when fines are at $20 or less. Findings also show that increased driver compliance with seat belt laws in secondary states is influenced by enforcement intensity – drivers were 18% more likely to be belted in states with high enforcement activity. Among drinking drivers and young adults, primary enforcement produces a substantial increase in likelihood a driver was belted. Findings will be useful in promoting more efficient seat belt interventions for rural areas based on alignment with state and local driver characteristics.