Public health policy is among the most effective and cost-effective interventions in some areas of public health and is emerging as effective in others. Policy may be especially important for rural communities, where residents face serious health and economic disparities and local health departments (LHDs) lack resources to provide necessary services. Data from the 2008 National Association of County and City Health Officials National Profile of Local Health Departments were used to examine policy activity (eg, policy development; communication with policymakers) and policy adoption in a sample of 454 LHDs. Results indicate policy activity was low in some policy areas for all LHDs and lowest in all policy areas for rural departments. Policy activities had significant positive relationships with policy adoption for land use (φ = 0.31; P < .05); tobacco prevention and control (φ = 0.37; P < .05); indoor air quality (φ = 0.28; P < .05); and nutrition and physical activity (φ = 0.21; P < .05). These relationships differed for rural, suburban, and urban LHDs. Significant positive correlations were also identified between overall levels of policy activity and any policy adoption (r = 0.16–0.27; P < .05). Local health departments should increase participation in policy activity to facilitate public health policy adoption nationwide.