Purpose This pilot study examined a telemedicine‐based intervention using motivational enhancement therapy (METelemedicine) to reduce alcohol use among a sample of at‐risk, rural alcohol users. Methods A total of 127 rural alcohol users were recruited from community supervision offices and engaged in brief intervention sessions using telemedicine. Analysis examined alcohol outcomes at 3 months postbaseline. Findings Findings indicated that although there were no overall differences between comparison groups on alcohol outcomes, 3+ sessions of METelemedicine significantly reduced the likelihood of any alcohol use by 72% (P < .05). In addition, 3+ sessions of the intervention predicted fewer days of drinking in the follow‐up period, fewer drinks per week, and fewer days experiencing alcohol problems. Conclusions Findings demonstrate that telemedicine may be a promising approach to deliver interventions with alcohol users who may not utilize formal treatment services. This method has potential to decrease some of the barriers to access and use of evidence‐based treatment for populations in need of services.