Introduction: In addition to socioeconomic factors, residents in rural areas face unique challenges that contribute to poor diet quality. We assessed Alternative Healthy Eating Index (aHEI) scores among residents of a rural county in New York with documented poor health outcomes. Methods: In 2021, we performed a cross-sectional survey of residents in Sullivan County, NY. This survey included questions on sociodemographics and a validated food frequency questionnaire (FFQ). We used multivariable linear regression to identify factors associated with lower aHEI scores, including: age, sex, race/ethnicity, household type, income, education, unemployment, disability, distance to grocery store, frequency of eating from canned foods and plastic-wrapped foods consumption (two attributes not captured in the FFQ), use of food support programs, food insecurity, housing insecurity, and difficulty meeting essential household and medical expenses. Results. Of 1,356 respondents analyzed, aHEI scores followed a normal distribution (mean: 56.5, standard deviation: 12.0). Adjusting for other factors, respondents that did not enter high school had an average aHEI that was 9.7 points lower compared to those that had completed college. Respondents reporting disability or food insecurity had lower aHEI compared to those that did not (respectively 3.6 and 3.2 points lower). Respondents consuming canned foods most of the time had a 6.0 lower aHEI than those that never ate canned foods. Discussion. We identified potentially modifiable risk factors for poor diet quality among rural residents. Efforts to reduce food insecurity along with better access to healthy foods in order to reduce canned food intake may be needed to address these rural health disparities. Disclosure C.Quintero arias: None. D.C.Lee: None. M.Rony: None. E.Jensen: None. A.Prabu: None. N.N.Wise: None. K.Doran: None. R.Anthopolos: None. B.Elbel: None. L.Thorpe: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)