OBJECTIVES The objectives of this paper are to describe the application of Health Impact Assessment (HIA) to inform trail decisions affecting a rural, under-resourced community and propose the routine integration of HIAs to enhance NEPA environmental assessments and environmental impact statements for trail decisions on federal lands. METHODS Screening, scoping, assessment, recommendations, reporting, monitoring and evaluation are being used to examine the health impact of trail location and design. RESULTS HIA recommendations are being integrated into the public lands National Environmental Protection Act process for planning access to a new segment of the Continental Divide National Scenic Trail. Potential users from a nearby rural New Mexico community and a region of almost one million may benefit from this HIA-informed planning. CONCLUSIONS HIA can be integrated into the policy and decision-making process for trails on public lands.