In October 2009, "JOPERD" published a special issue about "Engaging Urban Youths in Physical Education and Physical Activity." Seven years later, many of the considerations mentioned remain relevant, such as large class sizes, limited access to equipment, and the lack of a dedicated gymnasium or outdoor space. These structural challenges matter. Some data suggest that larger class sizes and indoor lessons are associated with students spending significantly less time in moderate-to-vigorous physical activity and with teachers spending more time on classroom management. In addition, high rates of teacher turnover, difficulties communicating with English language learners, and low self-efficacy affect teachers' ability to engage students in physical education in urban settings. The purposes of this narrative review are to identify the attributes of urban settings that influence how physical education is taught, and to provide action-oriented strategies for addressing challenges and for making the most of available resources.