Although federal law requires all public schools to be smoke free, lack of compliance with the smoke-free policy is commonly reported. The aims of this study were to describe the indoor fine-particle (PM(2.5)) air pollution in a rural high school and surrounding public venues. This cross-sectional, nonexperimental study was conducted in Monroe County, Kentucky (population of 11,756). Fine-particle concentrations were measured in the high school and 5 public venues using spectrometers. Because of illegal student smoking, PM(2.5) concentrations were 19 times higher in the boys' student restroom than the National Ambient Air Quality Standard for outdoor air (670 vs. 35 microg/m(3)). The staff restrooms adjacent to the student restroom where staff did not smoke also showed high PM(2.5) levels. Average indoor air pollution in the public venues was 158 microg/m(3). Strict enforcement of smoke-free school policy and cessation resources are needed to reduce secondhand smoke exposure. Collaborative school-community campaigns involving parents, students, mass media, and community organizations may be effective in reducing the harm caused by tobacco. Implications for school nurses are discussed.