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The purposes of this investigation were to examine whether pedometer-assessed physical activity (PA) in Appalachian Ohio students differed by body mass index (BMI), school level (middle school vs. high school), and gender during school days and nonschool days and whether students met the recommended PA guidelines. Participants (N = 149) were recruited from four schools in rural southeastern Ohio. PA was assessed using a sealed pedometer with a moderate to vigorous physical activity (MVPA) timer for 7 consecutive days. Univariate 2 . 2 . 2 ANOVAs showed boys and girls did not differ greatly in PA levels in middle school, but high school girls showed a much lower PA level than high school boys and middle school girls. ANOVAs also demonstrated BMI did not affect PA levels. The frequency data revealed that Appalachian Ohio youth showed relatively low PA regardless of BMI category, school level, and gender. However, the participants appeared to be more active during school days than nonschool days. Only 17% of participants met either one or both of the recommended steps per day and MVPA time per day, respectively, during school days. Behavioral interventions and policies are necessary to increase PA for youth in this region, especially high school girls.