OBJECTIVE: Climate change impacts the public's health. People are at risk for extreme weather events in the 21st century. The purpose of this study was to assess Public Health agencies' awareness of climate change's impact on health, and what protective and preventive strategies the agencies have in place. METHOD: Using mixed method research, a survey was designed to collect quantitative and qualitative data. Following IRB approval, surveys were sent to eight Public Health agencies in the USA's rural and urban Midwest, and rural Alaska. ANALYSIS: Quantitative data were analyzed using simple frequencies and means. Qualitative data were analyzed using content analysis and Public Health frameworks. RESULTS: Thirty-three agency personnel completed the surveys. All agencies identified emerging, new health problems. Seven agencies had climate change doubters and/or opposition from the community regarding climate change reality. All eight agencies were underfunded. CONCLUSION: Public Health agencies need financial resources to prepare for climate change threats and events. Climate change is a global reality. The world needs to collectively work together on this issue.