Background: The purpose of this study was to assess the school breakfast environment in rural Appalachian schools to inform school environment intervention and policy change. Methods: A total of 4 rural schools with fourth- and fifth-grade students in East Tennessee were assessed. A cross-sectional descriptive examination of the school food environment where food service managers submitted school menus, production sheets, and vendor bid sheets as part of the dietary data collection protocol for a school-based nutrition intervention study. The school breakfast environment was characterized in terms of calories, fat, saturated fat, and fiber from foods served on a per person basis using menus entered into Nutrient Data Systems for Research and production sheets for amounts of each food item served. Food items were grouped by the meal components of the School Breakfast Program (SBP) and ranked according to the items served most frequently. Results: Total fat provided slightly less than half the calories (43%); 15% of calories were from saturated fat. The top-ranked foods for each meal component were biscuits, sausage, 2% milk, orange juice, and gravy. Conclusions: Results suggest that clearer policies or regulations for the SBP are warranted to support policy efforts to promote childhood health. These should include technical assistance and provision of resources for school food service managers to provide low-fat meal options. Further research is needed to determine whether what is offered at school breakfast is actually consumed and how that might affect children's weight because of the high fat content. (Contains 2 tables.)