This study evaluates the trends and investments in Local Access Road (LAR) projects in Appalachia, U.S., over 20 years between 2001 and 2020. Information about 135 federally funded LAR projects is obtained from various data sources and classified by project type. Then, online surveys are designed for individual grantees or appropriate partners to verify realized performance measures and learn about the project successes, challenges, and experiences of project implementation. Follow-up in-depth interviews for selected projects are conducted with selected grantees, which provided more detailed information than the previous surveyed responses and firsthand stories from the grantees or involved stakeholders. About 65% of survey responses show differences between proposed and realized project outcomes (e.g., jobs created and leveraged private investment). The surveys and interviews suggest several reasons why grantees could not meet the targeted outcomes, including (1) changes in the macroeconomy, (2) effects of the COVID-19 pandemic, or (3) unpredictable challenges. While the LAR projects increase market access and business opportunities, create jobs, and leverage private investment, higher project costs do not always produce better outcomes. In addition, the interviewees share ideas about project funding and the characteristics of rural businesses. Lastly, some recommendations are offered for post-project evaluations and improvements to the LAR program.