The analysis of ground stone artifacts is a productive avenue for gaining useful information regarding the past societies of the North American Southwest. Here we present the results of the analysis of 255 ground stone items recovered from 76 Draw, a Medio period (AD 1200 to 1450) settlement in New Mexico. We find that locally available stone was used to make a variety of utilitarian items. We then compare the assemblage to previously reported ground stone assemblages from Paquimé (the economic and political center of the Medio period world) and nearby sites in northern Chihuahua, Mexico. We find that our assemblage is very similar to those from the smaller Medio period settlements but quite distinct when compared to Paquimé’s assemblage. Paquimé’s ground stone reflects an emphasis on non-utilitarian ornaments, religiously significant items such as effigies, and distinct utilitarian items such as well-formed metates produced by specialists. In contrast, the 76 Draw and other assemblages reflect an emphasis on utilitarian items produced at the household level. From this, we conclude that the social differentiation evident at Paquimé and reflected in its ground stone assemblage did not extend across the entire Casas Grandes region, even though utilitarian ground stone tools reflect the same technological system.