The majority of data on adolescent pregnancy pertains to urban communities, therefore, the individual and social influences associated with adolescent pregnancy in rural communities have not been extensively explored. The pregnancy rate among adolescent women aged 15 to 19 in rural Vance County, North Carolina, is 113.7 per 1,000, nearly twice the state average. This sequential mixed-method study used the social ecological model to evaluate the intrapersonal and community-related factors associated with adolescent pregnancy in this rural area. A quantitative survey assessed intrapersonal factors, namely sexual health knowledge, sex-related attitudes, and self-esteem in pregnant or parenting and nonpregnant or nonparenting groups. Two sample t tests revealed significant differences between groups relative to personal sexual values and attitudes toward premarital sex. There were no significant differences between groups for sexual health knowledge scores or self-esteem scores. Qualitative focus group discussions with one group, consisting of pregnant, parenting, nonpregnant, and nonparenting participants, assessed community opportunity structure as a behavior-influencing dynamic. Open-coding analysis revealed perceptions of strained employment and education-related structures, low community expectations of pregnant adolescents, and the influence of peer-related normative beliefs in early sexual intercourse. To bring about social change, community organizations should collaborate to engage participant-driven research while prioritizing the implementation of county-wide, comprehensive sex education programs. Improved programming could repair social norms, increase sexual health knowledge, and encourage personal responsibility over sexual health decisions.