Background: Antimicrobial resistance (AMR) is a growing global health threat, exacerbated by the overuse and misuse of antibiotics. Rural healthcare settings, where diagnostic resources are limited, are particularly vulnerable to antibiotic overprescribing. Understanding antibiotic utilization patterns and their relationship with AMR in rural outpatient settings is crucial for developing effective interventions. Objective: This study aims to assess antibiotic prescribing patterns, diagnostic testing practices, and the prevalence of AMR in the outpatient department (OPD) of a rural teaching hospital in Indore, India. Methods: A retrospective observational study was conducted analyzing 500 OPD prescriptions over 18 months. Data on antibiotic class, indication for use, empirical versus culture-guided prescribing, and diagnostic testing (culture sensitivity testing) were collected. Adherence to WHO guidelines and AMR trends were also evaluated, with resistance data obtained from the hospital’s microbiology department. Results: Antibiotics were prescribed in 57% of cases, exceeding the WHO threshold of 30%. Cephalosporins (39%) and fluoroquinolones (26%) were the most commonly prescribed antibiotics. Empirical prescribing accounted for 68% of cases, while culture sensitivity testing was conducted in only 15%. Resistance rates to fluoroquinolones and beta-lactams were observed at 40% and 35%, respectively. Conclusion: The study highlights the concerning overuse of antibiotics, particularly broad-spectrum agents, and the high rate of empirical prescribing. The low rate of diagnostic testing contributes significantly to AMR. Strengthening antimicrobial stewardship, improving diagnostic facilities, and ensuring adherence to guidelines are essential to combat AMR in rural healthcare settings.