This article describes rural methamphetamine (MA) production (“cooking”) and associated risks in Kentucky and Arkansas. It is based on qualitative interviews with 36 active MA users and one former user, a population that included 10 MA “cookers.” Participants reported that various forms of the Birch cooking method have become widespread locally over the past decade. There is an underground market in MA ingredients like pseudoephedrine pills and anhydrous ammonia and innovative methods to overcome restrictions on obtaining them. MA production is hazardous. Explosions, chemical spills, and injuries are associated with acquiring anhydrous ammonia. MA cooking is often undertaken by the inexperienced, those “high” on MA, or people who rush production because of fear of discovery or craving for the drug. Consequently, accidents and injuries sometimes occur. Lab waste is also a potential danger. Our preliminary findings can inform future research and the development of educational programs that address MA cooking and associated problems.