Food and physical activity access and availability in two contrasting cities in Alabama were investigated. An in-outlet, observational, cross-sectional design was utilized to assess the opportunities for healthy food choices and physical activity. Thirty retail food outlets and 29 physical activity outlets were inventoried. None of the convenience stores carried frozen, low-sodium or dark-green, yellow vegetables, low-fat milk or yogurt, low-sodium and low-fat cheese, while none of the supermarkets in Tuskegee stocked low-sodium vegetables. In Tuskegee, the single public recreational area, which offered activities such as basketball, fees ranged from $25 to $35/month. Tuskegee has a shortage of “chain” supermarkets and a dominance of convenience stores which stocked few healthy foods. Overall, there are limited opportunities for healthy food and physical activity choices, which could be a barrier for chronic disease prevention efforts.