The purpose of this study is to assess elementary school nutrition programs in a rural county in southern Illinois. The researcher interviewed the food service managers of eight schools and completed the School Health Index (SHI) based on their responses. Eighty-seven percent of the schools did not have venues such as vending machines outside the cafeteria. Three food service managers stated that from 75% to 80% of the students in the district ate lunch in the cafeteria. The SHI corresponds to the eight components of a coordinated school health program; nutrition services are just one of the eight components. The SHI is a tool that can be used to identify strengths and weaknesses in the nutrition program. It covers items from healthy, low-fat choices to food preparation and cafeteria practices. School nurses can work with teachers and food service personnel to create nutrition programs and a curriculum related to healthy nutrition practices. (Contains 2 tables.)