Within Australian cities there is significant socioeconomic disparity between communities, which is an obstacle to sustainable urban development. There is a voluminous amount research into the causes and some of the ameliorative actions to address socio-spatial disadvantage, though many studies do not localize or systematize their analyses. This paper presents the results of a co-design process conducted with community stakeholders using innovative realist inquiry and system mapping to answer the question: what are the impacts and drivers of socioeconomic and spatial disadvantage in a regional city in Victoria, Australia, and what actions might ameliorate these in three localities? Participants identified 24 separate causes and impacts of acute socioeconomic disadvantage. Using system maps, these community members developed 13 intervention ideas for action with potential to positively impact health and wellbeing, education, housing, employment, and livability, and be translatable to policy positions. The paper therefore presents a unique method of enquiry into spatial disadvantage and a grounded set of strategies for positive action.