This article looks at respiratory illness in Appalachian Kentucky because it reports some of the highest rates of respiratory illness in the United States. As part of the Mountain Air Project, local youth were invited to share their perspectives on possible contributing factors to respiratory illness, and the authors undertook an exploratory study to determine the utility of photovoice to elicit such perspectives with this population. This study demonstrates the value of incorporating youth perspectives in environmental health research, and that photovoice was a valuable approach to elicit such perspectives.