Of Iowa’s roughly three million people, one-third, or one million live in small towns with a population

below 10,000 (American Fact Finder 2017). Small towns tend to be rural locations with a strong

connection to agriculture and limited access to typical amenities needed to support human well-being.

Urbanization and small-town shrinkage is well-known but a lesser-known issue is the stabilization of

small town population size with immigrant and refugee communities. The invisible change in population

has multiple consequences, with some researchers suggesting that a growing urban/rural dichotomy

evidences a public health crisis due to a parasitic relationship between cities and rural environments [1].

The current state of research on local life in small towns reveals a critical knowledge-gap linking open

space with healthy behaviors: (1) currently, little data exists on the impact of small town environments

to contribute to healthy behaviors for vulnerable populations [2] ; (2) few post-occupancy evaluations

of such environments have validated efforts to overcome known social and physical barriers [3,4].

This lack of fundamental knowledge limits human and natural ecosystem services to support physical

and social activity. Our ‘Ground Truthing’ research (Fig. 2) used (1) transects to determine barriers

to healthy lives due to conditions in small-town peri-urban environments; (2) geolocated focus areas

across three cities for post-occupancy evaluation; and (3) in the process of surveying residents, local work force,

and decision makers for connections to existing ecosystem services. Findings hope to aid small towns in designing, planning, and developing policy to develop sustainable human and natural ecosystems. The presentation makes an important contribution to designers, planners, and researchers interested in improving small town environments for vulnerable populations.