Objectives. We evaluated lifestyle interventions for diabetic persons who live in rural communities. Methods. We conducted a 12-month randomized clinical trial (n = 152) of “intensive-lifestyle” (modeled after the NIH Diabetes Prevention Program) and “reimbursable-lifestyle” (intensive-lifestyle intervention delivered in the time allotted for Medicare reimbursement for diabetes education related to nutrition and physical activity) interventions with usual care as a control. Results. Modest weight loss occurred by 6 months among intensive-lifestyle participants and was greater than the weight loss among usual-care participants (2.6 kg vs 0.4 kg, P<.01). At 12 months, a greater proportion of intensive-lifestyle participants had lost 2 kg or more than usual-care participants (49% vs 25%, P<.05). No differences in weight change were observed between reimbursablelifestyle and usual-care participants. Glycated hemoglobin was reduced among all groups (P<.05) but was not different between groups. Conclusions. Improvement in both weight and glycemia was attainable by lifestyle interventions designed for persons who had type 2 diabetes and lived in rural communities.