The population of the Ounein Valley in the High Atlas Mountains in Morocco is at high risk of iodine deficiency. We investigated local children's iodine deficiency and goiter patterns as well as food consumption habits through a household survey. Median urinary iodine content and goiter analysis both reflect moderate iodine deficiency. Total fish consumption has a statistically significant, positive effect on urinary iodine content. Fish consumption, like that of salt, is closely related to market access. Respondents are uniformly unaware of the dietary etiology of goiter. An effective strategy to reduce the high incidence of iodine deficiency disorder among children in the valley must attend to four crucial issues: fish consumption, salt iodization, nutrition education, and market access.