Health promoting school activities have been implemented in developing countries, but their experiences have not been fully shared. Our objective is to explore the differences of health promoting school status in urban, semi-urban and rural areas in Lao PDR. To accomplish this we evaluated 138 schools in three provinces using a checklist developed by the government school health taskforce. We interviewed first through fifth grade pupils, school principals, food vendors, community chiefs, and observed school environments. We found that urban and semi-urban schools had higher scores than rural schools in the areas of, “personal health and life skills,” “healthy school environment,” “health and nutrition services,” and “common disease control and prevention.” However, semi-urban and rural schools showed better results than urban schools for some questions within the “school and community partnerships” component. When the results of individual schools were examined, there was considerable variation. We found a tendency for higher scores in urban areas, which went down for semi-urban areas and further decreased for rural areas. However, we also found differences among schools within each study site. In conclusion, we found not only a large difference among urban, semi-urban and rural schools but also clear differences in health promoting school status among schools within each study site in Lao PDR. Based on the results, we recommend that each school adopt a tailored approach for the health promoting school programme based upon an analysis of its own scores.