Gambling has become a popular activity in both urban and rural settings. Although the prevalence and participation of gambling is well known, little has been reported regarding the impacts of gambling on rural communities. Therefore, a narrative literature review approach was adopted to examine what is known regarding gambling in rural communities. This article describes the prevalence and types of gambling that are popular in rural communities around the world. It identifies the benefits and highlights the potential harm caused by a person’s gambling and the impact this has on families and the wider rural community. There are both benefits and risks associated with increased availability of gambling opportunities. Specific vulnerable groups within rural populations are identified within this context and how different countries respond to rural gambling is explored. A number of strategies based on a public health approach are recommended to ensure that gambling remains as harmless an activity as possible in rural communities.