Oral cancer accounts for 2.3% of malignancies in the U.S. and has one of the lowest five-year survival rates. An examination of oral cancer in Appalachia was motivated by the high incidence of lung and bronchial cancers in Appalachian states, the risk factors for which overlap with those for oral cancer. The incidence and mortality rates for oral cancer in 13 Appalachian states and the relative frequency of presumptive risk factors were examined and compared with national rates, using data from the National Program of Cancer Registries, Surveillance Epidemiology and End Results, Behavioral Risk Factor Surveillance System, the Appalachian Regional Commission, and the National Health Interview Survey. Combined incidence rates for oral cancer were higher in six of 12 Appalachian states, and mortality rates higher in 10 of 13, compared with the national average. Smoking was more prevalent than the national average in nine of 13 states, whereas alcohol consumption was the same or less in 11 Appalachian states. Only five of 13 states averaged fewer than the recommended five or more servings per day of fruits and vegetables.