Hello Justin
I'm glad that you were able to resolve your issue and thank you for posting your solution so that others experiencing the same thing can easily reference this!
Since the Microsoft Q&A community has a policy that "The question author cannot accept their own answer. They can only accept answers by others ", I'll repost your solution in case you'd like to "Accept " the answer.
Issue: Fix AppGateway Backend Health Root Certificate does not match Trusted Root Certificate
Solution: Some settings for the server/leaf certificates were missing. By using a .cnf-file with following properties, the setup works:
basicConstraints = CA:FALSE
keyUsage = critical, digitalSignature, keyEncipherment
extendedKeyUsage = serverAuth
subjectAltName = @alt_names
subjectKeyIdentifier = hash
authorityKeyIdentifier = keyid, issuer
[alt_names]
DNS.1 = www.fabrikam.com
# Add more DNS entries if needed
# DNS.2 = another-domain.com
If you have any other questions or are still running into more issues, please let me know.
Thank you again for your time and patience throughout this issue.
Please remember to "Accept Answer" if any answer/reply helped, so that others in the community facing similar issues can easily find the solution.