Pedestrian and bicycle planning has traditionally been viewed from an urban design perspective, rather than a rural or regional planning perspective. This study examined the prevalence and quality of pedestrian and bicycle plans in North Carolina according to geography, regional planning, and sociodemographics. Plan prevalence was lower, but plan quality tended to be higher, in rural areas compared with urban areas. Correlations between plan prevalence and active commuting were strongest in lower-income rural areas. By engaging in the planning process, rural residents and other stakeholders can support active living.