The threat and occurrence of terrorist attacks have increased in the United States since September 2011, heightening concerns for weaponized anthrax, other biological pathogens, and epidemics and pandemics. Early decisions and funding levels in local public health agencies can be the first line of defense or first point of failure; yet little is understood about how decisions are made when there are budget cuts before a biological event happens. Using Lindblom's conceptualization of limited rational choice theory, the purpose of this single case study was to understand how a local public health official made decisions after budget cuts in a single public health entity in the mid-Atlantic area of the United States. Data were collected through an interview with 1 public health official and publicly available plans, procedures, and funding documents. These data were inductively coded and then subjected to Braun and Clarke's thematic analysis procedure. Findings indicated that the public health agency's ability to make the best decisions were negatively impacted by limited resources, though adequate planning before a catastrophic event, active and continual communication with stakeholders, and clarity about financial and resource needs can partially offset the impact of budgetary reductions. The implications for social change include recommendations to anticipate and address the needs of the public health system through decision making to protect the health care community and the reduction or elimination of the spread of disease in the wake of a biological incident.