A critical prerequisite to the promotion of public health in local communities is gaining political support for local public health agencies and their activities. County governments are particularly important sources of support for public health agencies at the county level. This article deals with the issue of the priority given to public health by top county government officials. We determine that public health is generally a low priority issue for county government leaders. The low priority given to public health is, in part, linked to top county officials' lack of recognition of important public health problems and low levels of community group advocacy for public health issues. The problems that face public health in the political arena are related to the fact that many public health activities are not highly visible as political issues. An understanding of the relationship between public health and more politically salient issues can help health officials to raise awareness among county governmental leaders in regard to the importance of supporting public health activities. The data used in this study were collected from a survey questionnaire, which was mailed to 1,430 top county officials in 596 U.S. counties. The survey results were supplemented by observations made during site visits to 12 counties selected from four states.