A healthy rural ecosystem ensures a win–win situation for both economic growth and ecological conservation. However, the impact of land use changes at the rural level on ecosystem health remains unclear. This study focuses on the rural scale of Zheng–Bian–Luo, analyzing changes in land use from 2000 to 2020. Using the “Ecosystem Vigor-Organization-Resilience-Services” model, the study evaluates the spatiotemporal patterns of ecosystem health. The Patch-generating Land Use Simulation (PLUS) model was employed to simulate land use and ecosystem health in 2035 under three scenarios: Natural Development (ND), Ecological Protection (EP), and Cropland Protection (CP). The findings are as follows: (1) From 2000 to 2020, the area of cultivated land in Zheng–Bian–Luo rural areas decreased, and the area of forest land first decreased and then increased. (2) During the study period, ecosystem health improved as ecosystem vigor, organization, and services increased. Low-value areas of ecosystem health showed a shrinking trend, most notably in Kaifeng. (3) By 2035, under the EP scenario, forest land increased by 76.794 km2, while it decreased under the CP and ND scenarios. Construction land showed an increasing trend in all three scenarios, with the ND scenario seeing the largest increase of 718.007 km2. (4) In 2035, ecosystem health is projected to decline under the ND scenario due to reduced forest land and increased construction land. The CP scenario showed no significant change in ecosystem health, but the southwestern rural areas of Luoyang improved. The EP scenario saw an overall increase in ecosystem health, highlighting land use optimization as beneficial. Local governments are encouraged to create ecological protection plans balancing ecological and cultivated land protection, focusing on sensitive areas such as the Songshan region and southwestern mountainous areas of Luoyang for coordinated development.