Skin tone is a status characteristic used in society to evaluate and rank the social position of minorities. Although skin color represents a particularly salient dimension of race, its consequences for health remains unclear. The author uses four waves of panel data from the Coronary Artery Risk Development in Young Adults study and random-intercept multilevel models to address three research questions critical to understanding the skin color–health relationship among African American adults (n = 1,680): What is the relationship between skin color and two global measures of health (cumulative biological risk and self-rated health)? To what extent are these relationships gendered? Do socioeconomic characteristics, stressors, and discrimination help explain the skin color–health relationship? The findings indicate that dark-skinned women experience more physiological deterioration and self-report worse health than lighter skinned women. These associations are not evident among men, and socioeconomic factors, stressors, and discrimination do not explain the dark-light disparity in physiological deterioration among women. Differences in self-ratings of health among women, however, are generally explained by education and income. The results of this study highlight heterogeneity in determinants of health among African Americans. They also provide a more nuanced understanding of health inequality by identifying particularly disadvantaged members of racial groups that are often assumed to have monolithic experiences.