["The Journal of Rural Health, Volume 42, Issue 3, Summer 2026. ", "\nABSTRACT\n\nPurpose\nSexual minority (SM; vs. heterosexual) young adults (YAs) report disproportionately high cannabis use rates. SMYAs may use medical cannabis for unaddressed healthcare needs, especially in rural areas, which may have greater anti‐SM stigma and less healthcare access.\n\n\nMethods\nSMYAs (N = 549; ages 18–25, Mage = 21.75 [SD = 2.11]; 66.7% female; 45.5% gender minority; 32.6% rural‐residing; 44.6% racial and/or ethnic minority) in Oklahoma and surrounding states completed two waves of surveys (2023–2024). Regression‐based models examined: (1) direct associations of rural vs. urban residence with healthcare access (i.e., unmet healthcare needs, healthcare availability) and follow‐up cannabis use outcomes (i.e., any past‐month cannabis use, medical cannabis use); (2) direct associations of healthcare access with cannabis use outcomes; and (3) indirect associations of rural vs. urban residence with cannabis use outcomes through healthcare access. Models controlled for participant sociodemographics.\n\n\nFindings\nRural (vs. urban) residence was directly associated with greater likelihood of having unmet healthcare needs and less healthcare availability. Unmet healthcare needs were associated with greater likelihood of any past‐month cannabis use and medical cannabis use, whereas greater healthcare availability was associated with less likelihood of any past‐month cannabis use and medical cannabis use. Rural (vs. urban) residence was indirectly associated with greater likelihood of medical cannabis use through greater likelihood of having unmet healthcare needs and having less healthcare availability.\n\n\nConclusions\nCannabis use among SMYAs may be a response to unaddressed medical needs, especially in rural areas. Public health efforts should prioritize improving healthcare infrastructure in rural areas and creating affirming, accessible healthcare environments for SMYAs.\n\n"]