This study utilized data from the Family Life Project (FLP) to examine Head Start children's school readiness skills at the end of preschool in comparison to two other care groups: home-based care and other center-based care. The FLP study enrolled a birth-cohort of 1,292 children born in two historically low-wealth, rural regions of the U.S., with oversampling of children from low-wealth families and African American families. Propensity score weighting adjusted for differences in baseline child and family characteristics between the Head Start participants and children in the two alternative care groups. Research Findings: The results indicated that the Head Start group had higher literacy skills at the end of preschool in comparison to the home-based care group ([beta] = 0.36), but no other reliable differences emerged between these groups in school readiness skills. No reliable differences emerged between the Head Start and other center-based care groups in school readiness skills. Practice and Policy: Implications for educational practice and policy were discussed in relation to Head Start programming in rural America, including potential targets for program improvement and strategies for program expansion.