Four rural counties in Tennessee adopted the policy, systems, and environment (PSE) approach to address the obesity epidemic in their communities. The community-based participatory initiative, Community Coalitions for Change (C3), was embraced by 67,400 community members and 67 organizations. During year 1, coalition members discussed a need to return to long-held traditions of collective community engagement and action to address rural obesity rates. In response, C3 established 25 community gardens and supported 10 existing gardens, resulting in 8,300 community members who received garden produce. Sites began with an average number of 11 physical activity resources, which increased by year 3 to an average of 13 resources as a result of C3 activities. Overall, 61% (248 of 405) of survey respondents participating in direct education programs reported being more physically active as a result of participating in the programs, 59% (117 of 199) reported eating more fruit, and 66% (131 of 199) reported eating more vegetables. Implications for public health include timing and aligning obesity prevention activities with ongoing initiatives that are working toward similar goals.