Text messaging is a powerful communication tool for public health purposes, particularly because of the potential to customize messages to meet individuals' needs. However, using text messaging to send personal health information requires analysis of laws addressing the protection of electronic health information. The Health Insurance Portability and Accountability Act (HIPAA) Security Rule is written with flexibility to account for changing technologies. In practice, however, the rule leads to uncertainty about how to make text messaging policy decisions. Text messaging to send health information can be implemented in a public health setting through 2 possible approaches: restructuring text messages to remove personal health information and retaining limited personal health information in the message but conducting a risk analysis and satisfying other requirements to meet the HIPAA Security Rule.