Poverty lack of resources and pervasive adversity threaten the healthy social and emotional development of many children living in rural Appalachia. Despite these traumatic stressors, however, Appalachian residents have proven surprisingly resilient and responsive to intervention. This article describes the twin efforts of the Partnerships Program for Early Childhood Mental Health and Project LAUNCH, a community-university-state initiative, to transform school systems by establishing enduring partnerships within and across schools and agencies, pooling and disseminating critical resources, and strengthening the skills, confidence and capacity of the early childhood education workforce. This article describes the three-tiered framework of services implemented at the schools, with special emphasis on its trauma-informed training for educators combined with trauma-specific mental health interventions delivered on site. Despite a modest sample size, results indicate significant pre-improvement/post-improvement in teacher confidence and hopefulness in positively impacting challenging child behaviors; a decrease in the negative attributes of the preschool learning environment; and increased teacher ratings of child resilience as measured by the Devereux Early Child Assessment. Program limitations and future directions for creating trauma-informed Appalachian schools are discussed.