Since 2001, much research has examined national-and state-level preparedness against bioterrorism or naturally occurring epidemics. Few studies, however, have adequately addressed preparedness at the local level, and research to date indicates the difficulty of accurately assessing preparedness at any level. This study examined preparedness across the 35 health districts of Virginia in 4 defined categories of preparedness: personnel, services, technology, and emergency preparedness. Preparedness indicators were examined with respect to demographic, geographic, and critical infrastructure characteristics at the county and city levels. In all 4 categories of preparedness, the models obtained statistically significant results relating factors of demography, geography, and critical infrastructure to higher or lower levels of preparedness across Virginia. This study presents a methodology for public health researchers who wish to determine the preparedness of local health districts across the United States. It is intended that the combination of such research, based on local data, with larger, more general studies will paint a more accurate and constructive picture of preparedness.