Background. Family homes are a key setting for developing lifelong eating and physical activity habits, yet little is known about how family home nutrition and physical activity (FNPA) environments influence food insecurity (FI) and childhood obesity, particularly in rural settings. Aims. This study examined associations among FNPA, FI, and body mass index (BMI) in rural children. Method. Parents of 186 elementary school--age children completed FNPA and FI surveys. Child anthropometrics were directly measured. Logistic and linear regressions were used to examine associations. Results. Approximately 37% of children were overweight/obese; 43% of families were at risk for FI. Children whose families limited watching TV while eating were less likely to be obese (odds ratio [OR] = 0.56, p = 0.03) as were children whose families monitored intake of chips, cookies, and candy (OR = 0.54, p = 0.01). FI was higher in obese than normal weight children (OR = 11.00, p = 0.003) but only among families not eligible to receive free/reduced-cost school meals. Among eligible families, lower odds of FI were found for those who ate meals together often (OR = 0.31, p = 0.04) and for those with children frequently enrolled in organized sports/activities (OR = 0.65, p = 0.04). Findings were not significant after adjusting for multiple comparisons. Discussion. Results suggest that favorable FNPA factors were associated with healthier BMI and lower odds of FI. Conclusion. Opportunities for healthy eating at home may support rural children's weight health. Additional resources may be necessary to promote food security among low-income families. Future research is warranted to better understand FNPA in relationship to the disproportionate rates of obesity and FI in rural populations.