Objective: College students experience elevated rates of alcohol and sexual risk behaviors, but underrepresentation of rural institutions precludes tailored intervention. This study characterizes prevalence and short-term alcohol-sex risk at a rural institution. Participants: Undergraduates at a rural northeastern university. Method: Online health behavior surveys at Time 1 (T1; N = 327) and Time 2 (T2; n = 150, M[subscript interval] = 34 ± 7 days). Results: 75% reported lifetime, 73% past-year, and 65% past-month drinking at T1. Despite past-month sexual risk behavior (48% without barrier, 31% under influence of alcohol/drugs, 12% without querying STI status), only 23% endorsed past-year STI testing. Drinking students were more likely than non-drinking peers to endorse all sexual risk behaviors. T1 drinking was associated with T2 sex, sex under the influence of alcohol/drugs, and unprotected sex. Conclusions: College drinking predicted short-term sexual risk behaviors at this rural institution, suggesting potential unique risk mechanisms. Findings may inform multilevel, culture-centered intervention for students attending rural universities.