Due to industrial and lifestyle changes, rural and small town areas are losing population and suffering economic hardship. These areas also suffer from the poorest health. However, most rural or small town residents also believe in the American Dream, revitalizing their local area, and preserving the small town or rural way of life. In this paper, I look at the relationship between obesity and local infrastructure – including walkability and access to healthy food – in southern Illinois. I then make suggestions for development policies for the region in the context of local public opinion.