Open globe injuries (OGIs) represent severe ocular trauma requiring urgent intervention. This retrospective review characterizes ocular trauma—including OGI—presenting to Dartmouth-Hitchcock Medical Center from 2015–2025 and explores how rurality influences patterns of injury. Among 498 trauma-related encounters, most patients were male, White, and from rural or isolated towns. Falls and miscellaneous mechanisms accounted for the majority of injuries. A preliminary review of 18 OGI cases showed predominantly anterior (Zone 1) injuries, moderate severity (OTS Class 2), and low rates of eye-protection use. Intraocular foreign bodies occurred in 17% of cases. Rural residence may contribute to delayed access and distinct injury patterns. Findings highlight the importance of prevention strategies that address everyday risks, behavioral factors such as substance use, and barriers to eye-care access in rural communities.