Purpose Cardiovascular disease (CVD) is the leading cause of death for rural women in the United States. Lifestyle change interventions in group settings focused on increasing physical activity and improving nutrition have been shown to help reduce the risk for CVD. This paper describes the implementation and evaluation of Heart Smart for Women (HSFW), a 12‐week lifestyle behavior change intervention to reduce CVD risk for women in the rural southernmost 7 counties (S7) of Illinois. Methods The HSFW evidence‐based lifestyle intervention was delivered by a trained facilitator in 12 weekly 1‐hour sessions to groups of women in the rural S7 region of Illinois. Dietary and physical activity assessments were collected at baseline, postintervention, and 1 year. Clinical measurements were taken at baseline, 6 months and 1 year. Data were analyzed for change in behavioral and clinical outcomes over time. Findings In total, 162 women completed HSFW in 13 communities across the S7 region. HSFW participants showed improvement in dietary and physical activity indicators at the end of the 12‐week intervention, but only increases in vegetable consumption and physical activity were sustained over 1 year. A decrease in total cholesterol was observed at 6 months but not maintained at 1 year. Conclusions HSFW led to short‐term, moderate changes in nutrition and physical activity in rural women, but some health improvements were not sustained at 1 year. These findings suggest that more intensive follow‐up maybe required to help maintain long‐term behavior change, especially in rural areas where women are geographically dispersed.