Amid U.S. housing and labor shortages, Appalachia needs solutions that strengthen communities. This study examines how establishing an industrialized off-site construction (IOC) ecosystem can address regional housing, workforce, and construction challenges. From March–June 2024, we conducted seven participatory design workshops across Appalachia (n=129). Using a standardized prompt sequence (status quo, opportunities, IOC solutions), affinity clustering, and PICK chart prioritization, participants identified needs, capacities, and gaps, then ranked actions to advance IOC. Validity was tested through independent re-clustering with a shared codebook; inter-rater agreement was substantial (weighted κ=0.80). Five cross-cutting levers emerged: Education & Training; Policy & Regulation; Marketing & Awareness; Financing & Funding; and Technology & Innovation. Marketing & Awareness were consistently viewed as high-impact and easier to implement near term; Education & Training were high-impact but resource-intensive; Policy and Financing were impactful yet harder to shift; Technology & Innovation should be introduced incrementally to fit tradition-bound industry and regional norms. The resulting roadmap emphasizes near-term pilots, targeted talent pipelines, permitting/code alignment, and fit-for-purpose capital. The main contribution is a globally reproducible participatory protocol with transparent prompts, a shared codebook, independent re-clustering, and reliability metrics that enable replication and benchmarking across regions.