Local health departments play a vital role in helping communities prepare for and address the health effects of climate change. In 2012, NACCHO and the George Mason University Center for Climate Change Communication assessed local health department directors’ perceptions of the impacts of climate change within their jurisdictions; the priority of climate change adaption within their departments; and their assessments of their own departments’ and states’ expertise for responding to the impacts of climate change. This study aimed to gain a greater understanding of public health preparedness for climate change at the local level.