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This study is an inquiry of the barriers and facilitators that rural school districts encountered in their efforts to implement health and wellness practices. Our partnership with 27 rural school districts engaged in the implementation of over 600 evidence-based health and wellness practices serves as the context of this study. Through case study design, we conducted semi-structured interviews with representatives from each of the partnering school districts to identify 6 themes: 1) Funding and staffing; 2) Useful and practical materials and processes; 3) Collaboration within and beyond the school; 4) Actions and attributes of implementers; 5) Buy-in and openness to change; 6) The rural school context and community.