Health disparities are prevalent in rural communities across the United States due to compositional factors (socioeconomic status, race/ethnicity, health behaviors) and contextual factors (access to resources). We identify health behaviors and outcome implications for rural families across the multistate USDA Hatch Act–funded projects Rural Family Speak/Rural Families Speak about Health (RFS/RFSH). Project findings cover the cyclical nature of depressive symptoms, factors influencing household nutrition and physical activity behaviors, importance of social supports, and use of health information. We also identify principles for action within the Extension land-grant mission including (1) delivery through mobile formats, (2) incorporating multiple family members, and (3) building on Policy, Systems, and Environment (PSE) approaches both within Extension program areas and across systems levels in the community. Rural health efforts need further adaptation and implementation across diverse communities. Extension can achieve this though professional development and evaluation efforts.