Recent studies on obesity rates show alarming increases across the entire population. Some of these studies indicate higher rates of obesity in rural populations than urban and suburban populations. Obesity in children in rural places also outpaces their suburban and urban counterparts. Although a number of factors account for these differences, public health professionals and researchers have begun to recognize that conventional development patterns and land use policies in rural areas are playing an important role in the trend. Smart growth alternatives to current rural development patterns also support broad public health goals. Rural communities across America face a number of challenges, yet many are using smart growth development strategies to turn the challenges into opportunities. These strategies are structured in a way that builds on broadly held values in rural communities, ones that build upon the traditional development pattern and support multiple community goals. Public health professionals, managers, and academics will benefit from this discussion because it will explain the strategies that rural decision makers, planners, and citizens are adopting to create places that support multiple community goals including a built environment that sustains and promotes active living.