Background: Tobacco use leads to more deaths each year than any other single factor. This research examined teenagers' perceptions of anti-tobacco messages to determine which campaigns and educational approaches were most effective in preventing tobacco use among youth. Methods: Students from five rural high schools in western Pennsylvania were included in this survey-based study (N = 204). Results: A total of 30% of the study population reported current tobacco use. Tobacco users held more negative perceptions of anti-tobacco messages than non-users. A majority of students held supportive views about anti-tobacco education programs that were facilitated by peer leaders. Conclusions: Existing anti-tobacco campaigns and education are essential components of tobacco control initiatives. Students' perspectives provide novel insights that educators and campaign designers should consider as they develop anti-tobacco programs. (Contains 1 table.)