Foursquare ITP developed a transit service inventory and assessment, inclusive of both fixed-route and demand response services, that covered the 420 counties across 13 states served by the Appalachian Regional Commission. The presence and levels of services available (hours, days, trips) for both fixed-route services (present in 185 counties) and demand response (present in 394 counties) was systematically analyzed and presented in user-friendly maps and tables. The state of the rural transit in the Appalachia, as well as best practices and challenges, was documented through extensive analysis of the policies, programs, and organization of state-level rural transit programs. Input from over 100 providers in the Appalachian Region contributed to this analysis. The current use of federal funding, with particular focus on the use Appalachia Development Public Transportation Assistance Program (ADTAP), was also a key part of this review.