Community coalitions and agents funded by the Louisiana State University Agricultural Center's Healthy Communities program implemented multilevel obesity prevention interventions in 3 rural parishes (ie, counties) with an obesity prevalence of 40% or higher. The Healthy Communities coalitions appraised local health concerns through needs assessments and community forums. On the basis of local needs and the evidence base, the coalitions identified and implemented policy, systems, and environmental (PSE) strategies and supporting education to promote healthy behavior change among residents, overcoming barriers in the process. Interventions varied by parish but included Complete Streets implementation plans, healthy retail initiatives, play space improvements, downtown beautification projects, and Smarter Lunchrooms.