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Background  McDowell CHOICES (Coordinated Health Opportunities Involving Communities, Environments, and Schools) Project is a county wide endeavor aimed at increasing opportunities for physical activity (PA) in McDowell County, West Virginia (WV). A comprehensive needs-assessment laid the foundation of the project.    Methods  During the 6 month needs assessment, multiple sources of data were collected in two Town Hall Meetings (n = 80); a student online PA interest survey (n = 465); a PA and nutrition survey among 5 th  (10–11 years) and 8 th  graders (13–14 years) with questions adapted from the CDC’s Youth Risk Behavior Surveillance Survey (n = 442, response rate = 82.2%); six semi-structured school and community focus groups (n = 44); school site visits (n = 11); and BMI screening (n = 550, response rate = 69.7%).    Results  One third of children in McDowell County meet the national PA minimum of 60 minutes daily. At least 40% of 5 th  and 8 th  graders engage in electronic screen activity for 3 hours or more every day. The prevalence of obesity in 5 th  graders is higher in McDowell County than the rest of WV (~55% vs. 47% respectively). SWOT analyses of focus group data suggest an overall interest in PA but also highlight a need for increase in structured PA opportunities. Focus group data also suggested that a central communication (e.g. internet-based) platform would be beneficial to advertise and boost participation both in current and future programs. Schools were commonly mentioned as potential facilities for public PA participation throughout the county, both with regards to access and convenience. School site visits suggest that schools need more equipment and resources for before, during, and after school programs.    Conclusions  An overwhelming majority of participants in the McDowell CHOICES needs assessment were interested to participate in more PA programs throughout the county as well as to improve opportunities for the provision of such programs. Public schools were widely recognized as the hub of the communities and provide the best venue for PA promotion for both students and adult citizens, and can potentially serve as a platform for change in rural communities such as McDowell County.    Electronic supplementary material  The online version of this article (doi:10.1186/s12889-015-1702-9) contains supplementary material, which is available to authorized users.

Needs assessment of school and community physical activity opportunities in rural West Virginia: the McDowell CHOICES planning effort