Background: Needs assessments have been successful in helping congregations focus their health efforts; however, most have only incorporated leader perceptions. Understanding how perceptions of needs might differ between church roles (i.e., leaders and members) is a gap in the field. Methods: Church leaders (n = 369) and members (n = 459) from 92 congregations completed the 2019 Mid-South Congregational Health Survey. Chi-square tests and generalized linear mixed-models (GLMM) were performed to examine differences in the top 10 self-reported needs by church role. Results: Church leaders and members were: on average 55.2 (SD=15.2) and 54.3 years old (SD=15.5), women (63% and 78%), African American (91% and 90%), had less than a college degree (50% and 66%), attended churches with <351 members (67% and 61%) in low-income neighborhoods (70% and 60%), respectively. Chi-square tests indicated differences in six needs by church role: stress (p = .04), obesity (p <.0001), diabetes (p <.001), healthy foods (p <.001), youth programs (p <.001), and crime (p = .01). Adjusted GLMM revealed church leaders were more likely to report obesity (OR: 1.83, 95% CI: 1.33, 2.51), diabetes (OR: 1.73, 95% CI: 1.26, 2.37), healthy foods (OR: 1.42, 95% CI: 1.03, 1.96), and youth programs (OR: 1.40, 95% CI: 1.01, 1.95) as needs compared to members. Conclusion: Differences were found in needs reported by church leaders compared to members indicating the importance of including a variety of perspectives when conducting congregational health needs assessments. Such efforts will aid in the development of effective faith-based health promotion programs.