This document summarizes a conference held to discuss the issue of neonatal abstinence syndrome (NAS) among newborns in the Appalachian region. Experts from 8 Appalachian states discussed what is known about NAS epidemiology in the region, identified gaps in knowledge, and made recommendations. Common themes included the need for improved education of healthcare providers, treatment resources, and prevention strategies. The conference aimed to facilitate collaboration across states to address this growing public health problem.