Although influenza-associated illness is a major cause of hospitalizations and death among older Americans, only half of adults aged 50 or older—for whom influenza vaccinations are recommended—receive an annual influenza vaccination. National elections, which draw a large number of older voters, take place during influenza vaccination season and represent an untapped opportunity for large-scale delivery of vaccinations. In 2006, the Robert Wood Johnson Foundation launched a program to evaluate the feasibility of delivering influenza vaccinations near polling places. Twenty-five public health agencies were each provided grants of $8000 and asked to implement at least two Vote and Vax clinics. Immunizers were required to obtain prior permission from local election authorities and to charge fees as they would at their other community-based clinics. Influenza vaccination had to be made available both to voters and to nonvoters. On election day, the initiative delivered 13790 influenza vaccinations at 127 polling places in 14 states. More than 80 percent of adult vaccine recipients were in the Centers for Disease Prevention and Control–defined priority groups and 28 percent were “new” influenza vaccination recipients. Vote and Vax is a potentially national strategy that could significantly expand the delivery of influenza vaccinations.