Background <p>Rural populations have worse health outcomes than urban populations. Community-based health interventions can help to improve these outcomes, but rural populations are underrepresented in research. The goals of the study were to describe and examine the effectiveness and cost-effectiveness of strategies to recruit into a rural, community-based health intervention study.</p> Methods <p>The Change Club study is a community-based health intervention conducted in medically underserved rural communities in Texas and New York to assess whether a civic engagement program improves health among intervention participants and their communities. The study was promoted online, via mailings, email, educators, flyers/posters, and traditional media, and encouraged referrals from friends and family members. For each recruitment strategy, the resulting number of enrolled participants and costs were compiled.</p> Results <p>The most effective recruitment strategy was letters, which contributed 37.7% of participants, followed by friends/family (23.2%), postcards (22.3%), social media advertisements (13.3%), and flyers/posters (8.4%). The overall cost per enrolled participant was 12.36). The least cost-effective strategy was local educators’ phone calls and texts, which cost $6,803 and yielded no enrollments.</p> Conclusions <p>Mailing of recruitment letters, word-of-mouth referrals from family and friends, advertisements on social media, and the distribution and posting of flyers/posters were effective and cost-effective strategies and we recommend them for future studies in similar locations. Leveraging the close-knit social ties in rural communities to recommend study participation may be particularly fruitful, but researchers should investigate potential selection bias.</p> Trial registration <p>Clinicaltrials.gov, NCT05002660 Registered on 04 August 2021.</p>