Increasing rates of childhood obesity has prompted calls for comprehensive approaches to school-based physical activity (PA). The purpose of this study was to evaluate the feasibility of comprehensive school physical activity program (CSPAP) development and related contextual issues within a rural Appalachian county using a Systems Approach. A multicomponent needs assessment was conducted, including 11 school site visits with interviews with school personnel, physical space audits, and self-reported professional development, curricular, and equipment/resource needs. Data were summarized into case narratives describing context, space/facilities, and school assets/needs. Member checks verified the accuracy of narratives and inductive cross-case analysis was used to explore emergent themes. Six themes emerged: Leadership/Capacity Building, PA Access and Opportunities, Physical Education/PA Equipment and Resources, Physical Fitness Data Management and Reporting, Equity and Access to Safe and Usable Play Spaces, and Community Connections. Results support the feasibility of CSPAPs in rural communities and provide insight to factors influencing CSPAP. This study provides a framework for schools considering the development of CSPAP.