Aim: The aim of this study was to investigate the occurrence of alcohol poisoning in urban and rural regions of Belarus in the post-Soviet period. Methods: All-age male and female alcohol-poisoning mortality and population data were obtained for the years 1990, 1995, 2000 and 2005 for urban and rural regions of Belarus. These data were subsequently recalculated into three age categories and directly standardized. Poisson regression models were used to assess relative changes in rural-urban alcohol-poisoning rates across time. Results: Although extremely high in comparative terms in 1990, alcohol-poisoning rates had nevertheless risen considerably amongst men and women in all age groups in both urban and rural regions by 2005. In rural regions, the rise was continuous while amongst the urban population a small reduction was recorded in 2000 after a comparatively larger rise in 1995. By 2005, although alcohol-poisoning rates were significantly higher amongst rural men and women, the levels of acute alcohol mortality were nevertheless extremely high in nearly every age group in both urban and rural locations. Conclusions: It is probable that both the level and pattern of alcohol consumption in conjunction with the increasing use of illegal alcohol underlie the extremely high alcohol-poisoning rates in contemporary Belarus, and the growing rural-urban divergence in alcohol-poisoning mortality observed in recent years. Immediate action is now required to improve the poor social and economic conditions underpinning extreme levels of acute alcohol mortality, as well as to increase the provision of alcohol treatment services, especially in rural areas.