In the majority of U.S. schools, health education has been delivered in a fragmented and disorganized way resulting in poor quality. While studies have assessed the perceptions of health education from lead health education teachers and school administrators, a review of the literature revealed no studies of high school students' perceptions of school health education. The perceived experiences and perceptions of school health education among high school students have not been fully explored. The purpose of this study was to a) assess the perceptions of a 9th grade health education course from 10th and 11th graders attending a rural high school in West Central Alabama, b) identify students' self-reported current health behaviors and c) explore the relationship between the perceptions of their 9th grade health education course and reported health behaviors. Results showed that for each of the National Health Education Standards at least 60% of the students indicated that the course helped them to perform the standard. Results also showed that for each of the six CDC risk behaviors at least 50% of students indicated that the course helped them to make decisions about the risk behaviors. Additionally, at least 55% of high school students in grades 10-11 perceived their 9th grade health education course to be effective in helping them to make decisions about their general health and decisions related to the six types of health-risk behaviors that contribute to the leading causes of death and disability among youth and adults, a) behaviors that contribute to unintentional injuries and violence, b) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection, c) alcohol and other drug use, d) tobacco use, e) unhealthy dietary behaviors, and f) inadequate physical activity. Over 60% of 10th grade students and 55.4% of 11th grade students perceived their 9th grade health education course to be effective in preparing them to use decision-making skills to enhance health. Similarly, 10th grade students (70.8%) and 11th grade students (59.5%) perceived their 9th grade health education course to be effective in preparing them to comprehend concepts related to health promotion and disease prevention.