BACKGROUND: This study’s purpose was to assess the opportunities for North Carolina adolescents to be physically active in extracurricular middle school environments and to compare opportunities across community types. METHODS: Data were analyzed based on the results of an electronic questionnaire distributed to a sample of 431 schools with a response rate of 75.4% (N = 325). RESULTS: Nearly all schools offered interscholastic sports while fewer than half offered intramurals or non-competitive activities to students. “Open gym” was offered at only 35% of schools while 24% of schools offered extracurricular activities to students with disabilities. Overall, 43.4% of schools offered special transportation to students who participated in some extracurricular physical activities. Schools in rural areas generally offered fewer programs and had fewer supports than schools located in more urbanized areas. Over 2/3 of rural schools offered no extracurricular programs other than interscholastic sports. CONCLUSIONS: Schools can be important settings for physical activity. North Carolina’s middle schools and its rural schools in particular, are falling short in efforts to provide extracurricular physical activity programming recommended by researchers and policy groups. Lower accessibility to extracurricular physical activities may partially contribute to higher levels of physical inactivity found in the state.