Objective. This paper explores how communities translate evidence- based and promising health practices to rural contexts. Methods. A descriptive, qualitative analysis was conducted using data from 70 grantees funded by the Federal Office of Rural Health Policy to implement evidence- based health practices in rural settings. Findings were orga-nized using The Interactive Systems Framework for Dissemination and Implementation. Results. Grantees broadly interpreted evidence- based and promising practices, resulting in the implementation of a patchwork of health- related interventions that fell along a spectrum of evidentiary rigor. The cohort faced common challenges translating recognized practices into rural community settings and reported making deliberate modifications to original models as a result. Conclusion. Opportunities for building a more robust rural health evidence base include investments to incentivize evidence- based programming in rural settings; rural- specific research and theory- building; translation of existing evidence using a rural lens; technical assistance to support rural innovation; and prioritization of evaluation locally.