Affordability of a healthy diet is a determinant of nutritional intake and therefore health. This project aimed to measure the cost of healthy foods across a geographically defined region and examine factors related to changing food prices to assist in informing health promotion practice.The cost of a healthy food basket was measured using the Victorian Healthy Food Basket tool, in all eligible stores, across five rural local government areas in Western Victoria, Australia in 2014, 2015 and 2016. One-way analysis of variance was used to investigate differences in healthy food basket cost across years. Multivariable linear regression models were constructed to adjust for baseline (2014) cost to determine factors associated with cost.Data were collected from 45 stores in 2014 and 2015 and 48 stores in 2016. The average cost of the healthy food basket was $459 in 2014, $437 in 2015 and $443 in 2016. The cost of the healthy food basket was the highest in stores >15 km from the major regional centre and in areas with only one supermarket (non-cluster) (P < 0.05). All food groups except fruit and vegetables decreased in price between 2014 and 2016.This project highlights distance from regional centres and competition as possible factors that influence the cost of healthy food. SO WHAT?: This is valuable insight for health promoters in designing both local level interventions aimed at improving access to healthy food and influencing regional food systems.