AbstractPurposeTransactional sex is associated with an array of other health risk behaviors and adverse health outcomes, including HIV. However, despite concerns regarding a potential HIV outbreak, there is limited understanding of transactional sex among rural Appalachians who engage in high‐risk behaviors. Thus, the current study describes the prevalence and correlates of transactional sex among a sample of rural, justice‐involved Appalachian women who use drugs.MethodsParticipants (N = 400) were randomly selected, screened, and interviewed face‐to‐face at 3 rural Appalachian jails in Kentucky. Bivariate analyses were used to examine differences between those who reported trading sex for drugs, money, goods, or services in the year prior to incarceration and those who had not, and multivariable logistic regression was used to examine independent correlates of transactional sex.FindingsOn average, participants were 33 years old with 11 years of education. They were predominantly White (99.0%), about half (43.7%) reported lifetime transactional sex, and 25.9% reported past year transactional sex. Past year transactional sex was positively associated with experiencing money problems, substance use problem severity, injection drug use, unprotected sex with a casual partner, and number of sexual partners in the year prior to incarceration.ConclusionsResults suggest that transactional sex is fairly common among rural Appalachian women who use drugs and are justice‐involved and may signal other HIV‐related risk behaviors. Given limited service availability throughout rural Appalachia, findings emphasize a need for increased access to risk‐reduction interventions, including jail‐based interventions, to educate vulnerable, hard‐to‐reach populations on the risks associated with HIV.