Background: Young children who are overweight and obese may be at a greater risk of hypertension, and those from rural and low socio-economic areas may also exhibit a prevalence of metabolic dysfunction and cardiovascular risk. This study evaluated the relationship of body mass index (BMI) and blood pressure in children from a rural, low socioeconomic community in Alabama. Methods: This cross-sectional study was comprised of young children (aged 5-9 years). BMI (normal, overweight, obese) was assessed using standardized procedures and classified based on the Centers for Disease Control Growth Charts. Blood pressure status (normal, pre-hypertension, hypertension; stage 1 and stage 2) was defined by percentiles of the 2nd and 3rd reading on a single occasion. A MANOVA was used to determine the relationship of BMI to mean blood pressure (i.e., systolic and diastolic). Results: Of the 134 participants (78% non-Hispanic Black), 10 (7.5%) were overweight and 25 (18.7%) were obese. Pre-hypertension and hypertension were detected in 9 (6.7%) and 20 (14.9%) children, respectively. Results indicate that mean systolic and diastolic blood pressure significantly increased with BMI, P < 0.001 and P = 0.028. Conclusion: Hypertension was strongly associated with an unhealthy BMI in these young children from a rural and low-socio-economic community. The findings raise concerns about the growing epidemic of childhood obesity and hypertension in young children and warrant the need to investigate lifestyle behavioral interventions on BMI and blood pressure.