‘Regional food systems’ appears with increasing frequency in scholarly works and among food system practitioners. Yet regional food systems are understudied and undervalued. Much more attention to regionalism and regional food systems is necessary to create more sustainable, equitable, and resilient food systems for all. Building from the authors’ 2010 paper, “It takes a region… Exploring a regional food systems approach: A working paper,” this greatly expanded report explores the concepts, practices, challenges, and promise of regional food systems. The report’s focus is on the Northeast U.S., a laboratory for regional food systems thinking and action, but it also describes and gives examples of regional food systems development across the country. The arguments in favor of regional approaches and explorations apply to all regions and embracing them could not be more imperative to address contemporary conditions.