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Research shows that interest is often reported as a primary reason for career choice selection among majority students but not necessarily for underrepresented students. At the same time, research focused on rural Appalachian youth in Virginia and Tennessee (students underrepresented in higher education broadly and specifically within engineering) has shown interest as preferentially important in engineering fields though not in other fields. To better understand how interest in engineering is sparked and sustained among Appalachian students, we used a qualitative multi-case study approach to first compare interest in engineering and healthcare fields among high school students and then to compare high school and college student interest in engineering careers. For high school students, our findings reveal interest sparks in engineering were more likely to be associated with organized experiences, while health care interests were primarily associated with personal experiences. We also found an association between engineering interests and a preference for math and science classes, but the same association did not exist for interests in health care fields, despite the potentially equivalent math/ science intensity of these career fields. With regard to interest development phases among high school students, individual rather than situational interests tend to be associated with intention toward engineering majors, whereas the opposite was true for healthcare fields. For college engineering students, we identified a greater balance between individual and situational interest than in the high school sample of students interested in an engineering career. College students were also more likely than high school students to indicate a personal experience as sparking his or her interest in engineering than an organized activity. Finally, though we compared two case sites in rural Appalachia, our findings revealed commonality in interest levels and sparks across sites. In combination, these findings have implications for designing interventions intended to spark interests in engineering such that the interests can also be sustained. [ABSTRACT FROM AUTHOR]