Researchers have examined ways in which policy makers develop their decisions. The literature has not explored, however, the methodologies used by county managers to arrive at decisions, or whether they consider the medium- and long-term policy implications, or second and third order effects, of those decisions. The purpose of this study was to identify the methodologies and decision-making processes used by county managers in North Carolina. The theoretical framework was Lindblom's theory of incrementalism in decision making. Data for this phenomenological study were collected through semi-structured interviews with 10 purposefully selected county managers, and were coded and categorized to identify themes and patterns. Results indicated that county managers tended to rely on multiple methodologies, rather than one consistent methodology, when deciding public policy issues, and that they overwhelmingly considered the second and third order effects of their decisions on public policy outcomes. The implications for positive social change include informing country managers and the public about policy decisions and their effects on the long-term well-being of their local community.