Local health departments seem to constantly find themselves in a state of transformation, adapting and responding to shifts in politics, culture, science, and economics. Most recently, healthcare reform challenged local health departments to grapple with their core identity and posed challenges to the way many agencies have always done business. Now more than ever, it is important for local health departments to assert their role and value in the communities they serve. One health department in Montana has successfully tackled this challenge time and again.