Background: Many local health departments are working to meet new public health accreditation standards. One important step includes conducting a community health assessment, which may include a survey designed to identify key health problems within a community. There is little published work examining public health departments' experiences conducting such surveys. This study describes the process of developing and implementing a community health assessment in a predominantly low-income, agricultural county of California. Methods: Survey questions were developed from existing surveys and input from community partners, including elected officials and underserved groups. After extensive pilot testing, the final survey was administered in multiple locations (including public health clinics, farmer's markets, and community events) via self-administered questionnaires, oral interviews, or Qualtrics online survey software (each available in English and Spanish). Maximizing community engagement was prioritized over obtaining a representative sample of the county population. Results: The survey development and implementation process took 8 months. Training local volunteers were essential to engaging the elderly, veterans, those with low literacy, and individuals speaking Native American languages or other regional dialects. A total of 2,189 community members responded. Respondents were largely female, low-income and Hispanic. The top three health problems reported by respondents include alcoholism/drug abuse, breathing problems, and obesity/diabetes. Conclusion: The survey process was more resource-intensive than anticipated. Investing time and energy to establish solid relationships with community partners was necessary to ensure successful data collection. In ethnically diverse, low-income settings, survey methods should be flexible to maximize inclusiveness and culturally appropriate data collection.