We examined associations between adults’ use of a prominent rail-trail and their weight status and self-rated health. In 2014, a random-digit-dial survey of Greenville County, South Carolina, residents (n = 639) was used to collect data on trail use, height and weight, self-rated health, and demographics. Trail users were half as likely to be overweight or obese as trail nonusers (odds ratio [OR] = 0.56; 95% confidence interval [CI], 0.33–0.95). Similarly, trail users were significantly more likely to report high self-rated health than were trail nonusers (OR = 1.83; 95% CI, 1.13–2.97). Findings suggest that trail use is associated with healthier weight status and higher self-rated health and supports the development, maintenance, and promotion of trail resources.