People living in rural America face unique social circumstances that can prevent them from reaching optimal health status. This fact holds especially true in the rural Appalachian region of the United States where income, education, living circumstances, and lack of resources create an environment that has some of the highest rates of morbidity and mortality in the country. While the rest of the country has seen improvement in many health behaviors and health outcomes, rural Appalachian communities remain unchanged and further behind other regions. In many cases, programming and policy have failed to create a culture of health in Appalachia. Social determinants of the area should be included in interventions and this practice is imperative to achieve effectiveness. This study examined the social context and definitions of health in a rural, Appalachian community using the Social Quality Theory as a guiding framework. A community-based participatory research approach was adopted and implemented through the use of focus groups. The study generated many meaningful findings. It not only provided a new framework, but also provides an examination of how a rural, impoverished community lacks the social infrastructure to improve health. Current perceptions of health are limited to thoughts of disease or illness and overshadowed by negative social norms. There are few social resources currently available to improve health and a large presence of cultural impediments. Yet this “culture” also provides some advantages and assets that the community may leverage for change.