Recent increases in opioid overdose rates have changed the role of first responders on the front lines of this national crisis. The present study used a semi-structured qualitative interview to investigate how the increase in opioids, opioid-related harm, and opioid-related death within Tennessee has affected the first responder population. Law enforcement officers, firefighters, and paramedics (N = 30) from rural-serving counties in Tennessee completed a semi-structured interview. Eight themes emerged from the interviews: (1) mental health symptoms, including posttraumatic stress disorder and secondary traumatic stress symptoms; (2) coping behaviors; (3) available resources; (4) barriers to accessing resources; (5) recommendations for what is needed; (6) hardest circumstances; (7) discrepant thoughts and feelings; (8) perception of role in reducing the impact of the epidemic. This study provides novel insights into the impact of the opioid epidemic on Tennessee first responders, and can inform future efforts to reduce adverse outcomes in these care providers.