Lesbians are underrepresented in women’s health research. Research exploring lesbians in rural environments is virtually nonexistent. The current study adds to the knowledge base of lesbian health and explores the perceptions of body image, fitness, and health for both lesbians and heterosexual women in rural communities. Findings from exploratory analyses indicated that both groups of women are significantly overweight. However, lesbians exercised more times per week than heterosexual women. Results demonstrated that lesbians with college educations had more positive body image and fitness self-perceptions, whereas heterosexual women with college educations had less positive body image and fitness self-perceptions. Findings have implications for direct practice with lesbians in physical and mental health service settings.