Little is known about food insecurity rates among first-generation college students in Appalachia. This study examines food insecurity and associated risk factors among first- and continuing-generation college students attending an Appalachian university in the Fall of 2019. Students completed an online Qualtrics survey that measured food security status using the 2012 US Department of Agriculture ten-item Adult Food Security Survey Module. Multivariate logistic regression models explored factors that influence food insecurity among first-generation students. Of respondents (n = 2,653), 723 were first-generation and 1,930 were continuing-generation. Food insecurity prevalence among first-generation students was 15.7 percent higher than among continuing-generation students. Black first-generation college students were 296 percent more likely to be food insecure compared to white students. First-generation students were more at risk if they experienced childhood food insecurity but were lower risk if they were aware of campus food resources. As first-generation college students experience food insecurity, resources are needed to help transition them into campus life. Screening for childhood food insecurity among incoming college students could help to distribute resources to students in need. Promotion of campus food resources may make students aware of available protection against campus food insecurity.