There is increased awareness in recent years of mental health challenges faced by children in rural schools. Although much of the media attention is on internalization disorders (e.g., depression and suicidal ideation), externalization disorders (e.g., oppositional defiant disorders, attention deficit disorders, and conduct disorders) are more commonly referred within rural districts. It is common for classroom teachers to deliver stickers to students for positive behavior that can be exchanged for larger rewards. It is also common for students to lose privileges based on marks for bad behavior. These procedures are similar to traditional token economy and response cost interventions. Most of the empirical support for these interventions is based on studies of individuals with disabilities in large cities near universities. This study compared the efficacy of token economies, response cost, and a combination condition implemented class-wide in two rural elementary school classrooms. The token economy was most effective in reducing problem classroom behaviors and increasing academic engagement compared with response cost and baseline. The combination condition produced outcomes similar to that of the token economy. Social validity measures were mixed, with some teacher support for response cost based on ease of implementation. Students and teachers, however, endorsed all approaches as beneficial for improving behavior.