The rural United States, including West Virginia, has decades of experience engaging communities and utilizing community health workers (CHWs). This study aims to inform policy and planning by comparing how 2 county-level CHW programs engage with communities. The analysis is based on in-depth interviews with 19 community representatives and 20 health workers and archival documents and published literature reviews. Results highlight the local contextual determinants for community engagement with CHW programs. Making CHW policies inclusive and adaptable to local realities will enable more community benefits. Making the value of CHW programs for communities explicit should guide resource allocation and policies.