Both the prevalence and importance of rankings have grown considerably in cases where a characteristic cannot be captured using a single variable. A prime candidate for the use of rankings is county-level health in the United States. Given county health's multidimensional nature, researchers, policymakers, and other stakeholders regularly use rankings to combine information from multiple sources into a single outcome. The most commonly used county health rankings (CHRs) are the University of Wisconsin Population Health Institute's (UWPHI's) CHRs.Since 2010, the CHRs have been used to allocate scarce resources, design health policy, and demonstrate need for health improving interventions. In 2012, the San Bernardino County Health department used the CHRs to support their Healthy Communities initiatives program, offering $100,000 dollar seed grants to participating counties (County Health Rankings and Roadmaps, 2012a). In Lima Ohio, Active Allen County relied on the CHRs to engage with the Ohio Department of Public Health and local stakeholders to improve health in their county, receiving a $1.2 million Community Transformation grant from the Centers for Disease Control and Prevention (County Health Rankings and Roadmaps, 2013). The Greater Flint Health Coalition implemented a 10-year County Health Rankings Action Plan to