OBJECTIVE To understand what tools, resources, and assistance are needed for local health departments (LHDs) to successfully engage in quality improvement (QI) and to generate examples of successful QI efforts. METHODS With funding from the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, the National Association of County & City Health Officials supported 66 LHD demonstration sites between 2007 and 2009. The sites measured themselves against national standards and addressed priority areas for improvement through the application of QI techniques. We used on-line surveys, interviews, and informal collection of participant feedback to determine the usefulness of resources that were provided for QI efforts. RESULTS Participating LHDs lack a common understanding of formal QI. Several existing QI resources specifically geared to public health are very useful, and in-person assistance is highly valued. CONCLUSIONS The value of Web-based sessions is uncertain, and state and national meetings could provide accessible forums for in-person training. Dedicated time to training and implementation, coupled with widespread sharing of best practices and success stories, could enhance the uptake of QI efforts in LHDs. Additional studies regarding sustainability are needed to understand how to institutionalize QI.