Rural areas are facing vulnerabilities and changes caused by negative social, economic and ecological externalities resulting from industrial agriculture systems. Locally embedded farms and bottom-linked approaches such as social cooperatives that act in the field of social agriculture are small, but valuable models to counteract these trends. This article is based on a case study conducted within the transdisciplinary research and development project Unlocking the Potential of Social Agriculture (UPAS), 2017–2020—financed by the Free University of Bolzano. The main focus of the case study is to determine the impact of social agriculture initiatives on social and healthcare systems, the natural environment and the communities in which they act. Data collection includes a literature review, observations and interviews carried out on 35 case studies of social agriculture initiatives, mainly located in Italy. The field research points out that actors in the sector of social agriculture predominantly aim to integrate disadvantaged people socially and in terms of their labor, base their production on organic methods, and that social agriculture has the potential to foster eco-social transformation and development of rural areas by the combination of social and ecological concerns. Thus, we use the term “eco-social” agriculture to describe these approaches. Furthermore, five components of eco-social agriculture have been defined, which, together, offer an ideal set of acting principles, namely: (1) the empowerment and integration of disadvantaged people, (2) the promotion of environmentally friendly agricultural practices, (3) the protection of nature, resources and cultural landscape, (4) support to the local community, and (5) education for sustainable development.