North Carolina passed legislation to implement recommended nutrition standards in schools. A pilot study conducted in 2004-05 in seven school districts (123 elementary schools varying by size, region, and demographics) resulted in substantial revenue loss and resistance from administrators, teachers, parents, and students. We propose an in-depth analysis of the financial impact and implementation barriers among key stakeholders in this pilot as well as in 2 middle schools (average 50% free and reduced lunch, 85% minority) where changes to healthier a la carte items also resulted in substantial revenue loss. This will involve extensive economic analysis and qualitative data collection among stakeholders.