The Appalachian community in the Lower Price Hill (LPH) neighborhood of Cincinnati, Ohio, used community-based participatory principles and methods to develop, implement, and evaluate an on-going initiative to address the high prevalence of diabetes among its residents. Led by the Urban Appalachian Council in partnership with a number of academic and community organizations, the initiative conducted town hall meetings of LPH residents to identify diabetes-related areas that needed to be addressed and to select an initial pilot intervention. The result was a Community Health Advocate (CHA) program which trained neighborhood residents to canvass households to conduct diabetes risk assessments and provide education on diabetes prevention, schedule follow up diabetes screenings at a wellness site established by the community, and conduct follow-up telephone calls to ensure wellness site participation. The extensive case-finding effort by the CHAs led to the identification of a substantial number of previously undiagnosed residents as high risk for diabetes. This effort also resulted in the confirmation of the community's perceptions of other diabetes-related need areas which are being addressed through subsequent interventions. The success and acceptance of the program demonstrates that an Appalachian community can use existing resources to enhance its own capacity to address its health issues.