PURPOSE: Alcohol consumption is higher in regional and rural areas compared to metropolitan locations, but it is unclear which areas suffer different levels of harm. The current study investigated the rates of alcohol-related injury presentations at emergency departments (EDs) in Victoria, Australia, across metropolitan, regional, rural, and remote areas, and within coastal locations. METHODS: Using ED injury presentations data for Victorian hospitals from June 1999 to June 2011, the trends in alcohol-related injury rates over time were investigated. FINDINGS: Compared to metropolitan locations, alcohol-related injuries were higher in larger regional and rural areas and similar in small rural towns. The rates of alcohol-related injuries are also significantly increasing over time for regional and rural locations. Lastly, for males, rates of alcohol-related injuries increased in coastal areas during November to February compared to the remaining months. CONCLUSIONS: Regional and coastal areas experience increased alcohol-related injury rates. The causes of this have yet to be investigated and future research is required to determine why and what interventions may be most effective at reducing these harms.