Purpose: To address the obesity epidemic and promote children's health; several health organizations recommend that schools develop comprehensive programs designed to promote physical activity and health behavior. Given a lack of empirical investigation, the authors sought to understand how physical education programs are perceived within such initiatives. Methods: A case study was conducted to acquire insights of key stakeholders (N = 67) in a school nationally recognized for promoting physical activity and health. Data were collected using formal interviews, informal interviews, observations, and document analysis. Data were analyzed utilizing grounded theory and constant comparison. Results: Physical education was viewed positively by stakeholders; however, physical educators felt marginalized within the school infrastructure. Systemic barriers to program quality included lack of leadership, feelings of marginalization, and insufficient funding and collaboration. Discussion: Findings raise concerns about the difficulty of sustaining a high-quality physical education program even in a school recognized for significant support of physical activity.