University of Pittsburgh medical students interested in rural public health sought community partners for a service-learning project. Faculty introduced students to Pittsburgh-based nonprofits that are committed to environmental health. A community based organization (CBO) facilitated dialogue with West Virginia landowners who were affected by unconventional natural gas development. Meetings with local activists and stakeholders in Fayette County, West Virginia revealed a legally complex public health situation. Furthermore, there was consensus that the CBO's validated environmental health assessment could not be implemented in a way that would inform local decision-making. Representatives of the Fayette County Health Department requested a broader survey to encompass other social determinants of health. At this time, representatives from New River Health, a regional FQHC, were invited to contribute to the planning and implementation of the assessment. Multiple survey drafts were evaluated but ultimately deemed redundant with existing data. Collaborators agreed that qualitative data were needed to enrich the existing data. With assistance from the University of Pittsburgh School of Public Health, the partners designed a qualitative research tool that was implemented by Health Department volunteers and over twenty medical students. Community members determined the sites for implementation, which included a New River Health clinic. Medical students analyzed the data and produced a report that was shared with local stakeholders. With the results in mind, the partners are discussing future initiatives, including advocacy in the state legislature and a local initiative to address prescription drug abuse.