Social environments exert an important influence on nutrition and physical activity behaviors, yet few studies have examined the meaning of social ties in relation to the health of rural communities. This work explored how social relationships influence the adoption and maintenance of health‐related behaviors among midlife and older rural adults. Seventeen focus groups were conducted with 126 sedentary, overweight/obese adults aged 40‐91 years residing in government designated “medically underserved” rural Montana towns (average population <3,000). Groups were stratified by age (40‐64 and 蠅64) and gender. Transcripts were examined thematically according to social facilitators and barriers to healthy eating and physical activity. Results indicated that social ties had both health‐promoting and health‐damaging effects. Support from and accountability to family and friends were common facilitators of behavior change and maintenance. However, expectations to conform to social norms in these isolated communities often hindered healthy eating and physical activity. Participants reported feeling that ingrained ideas of what constituted a meal (e.g. meat and potatoes) and obligations to eat at social gatherings were barriers to adopting/maintaining healthier eating. These findings suggest that interventions targeting adults in rural settings need to consider the impact of social relationships in both supporting and sabotaging health behavior change and maintenance strategiesFunded by NIH/NHLBI, R01 HL120702‐01.