The development and sustainability of small businesses impact the U.S. economy. Owners of small businesses created 65.9% of new jobs between 2000 and 2017. Over 99.9% of known U.S. firms were small businesses. The purpose of this multiple case study was to explore the leadership strategies small fitness business owners implemented to sustain their businesses for longer than 5 years. The conceptual framework for this study was the servant leadership theory. The population for the study included 5 owners of small fitness businesses in the southeastern region of the U.S. who used leadership strategies to sustain their businesses for longer than 5 years. Data were collected using semistructured interviews and analysis of data from their business performance plans and financial statements. Data were analyzed using Yin's 5-step process. A transcription and coding software, methodological triangulation, and member checking were used during data analysis. Good business practices, leader characteristics, and leader relationships were the themes identified during data analysis. Company reputation, customer-service management, financial management, and marketing were minor themes of effective business practices, while adaptable, motivated, and work ethic were minor themes of leader characteristics and family-like and industry networks were minor themes of leader relationships. The implications of this study for positive social change relate to improving the economy, health, and overall well-being of community members through sustained small fitness business owners who provide jobs and access to preventive healthcare options.