Approximately 70% of American high schools enroll 1000 or more students each, while almost one half of high schools enroll more than 1500 students each. A growing booty of evidence, however, is showing that small schools, especially small secondary schools, result in positive benefits for students, families, and communities that go beyond letter grades, Investigators have found that smaller high schools result in greater academic achievement, higher faculty morale, less student misbehavior, and greater family satisfaction. Recommended strategies to create a more personalized high school experience and improve performance include creating smaller "schools" within large schools, instituting career academies, reworking the school day, and employing teacher advisory systems. This article describes the prominent elements of effective small schools with implications for a strengthened "presence" of the coordinated school health program at the high school level.