Early care and education settings are essential partners in the battle against childhood obesity. We describe an Extension-facilitated early childhood obesity prevention intervention conducted in 25 rural early care and education settings. A total of 148 policy, systems, or environmental changes were achieved, reaching approximately 450 young children. Systems changes were the most prevalent outcome achieved. The experiences of Extension professionals in promoting policy, systems, and environmental changes are highlighted as are implications for other Extension systems and professionals promoting policy, systems, or environmental changes in early care and education settings.