Rural disparities in health behaviors and weight status jeopardize the well-being of millions of Americans. Compared to urban children, rural children have higher rates of obesity and consume more calories, less fruit, and fewer vegetables. A health-promoting school environment can modify risk behaviors, and periodic assessment of school environments provides crucial information about opportunities for improvement, but national surveillance options are limited. There is also a need to gather nuanced information about the factors that support or limit implementation of systems changes at rural schools. The Food and Fitness survey, part of the RWJF-funded Bridging the Gap Research Program, surveyed a nationally-representative sample of 640 public elementary schools in 2013-14. This project will re-survey schools to examine changes between 2013-14 and 2019-20, with a sample large enough to examine disparities. Aims are to: 1) examine changes in school practices between 2013-14 and 2019-20; and 2) identify the unique strengths and challenges of rural schools, through collection of qualitative data in a purposive sample.