Like politics, public health is always local. The Department of Health and Human Services (DHHS)/Centers for Disease Control and Prevention (CDC) echoes this view when discussiong preparation for pandemic influenza: "The local level is where the effects will be felt and where the response needs to occur." 1 Public health agencies and professionals are in a prominent position when it comes to planning and response to pandemic influenza; they must ensure that core functions and essential services remain functional and that living conditions remain healthy. The purpose of this commentary is to reflect on the role of local health departments in preparing for pandemic influenza.