In anticipation of the Presidential election and the entry of a new Administration, the National Academy of Medicine (NAM) launched the Vital Directions for Health and Health Care Initiative in 2016, which convened more than 150 leading researchers, scientists, and policy makers to provide expert guidance on 19 priority issues for U.S. health policy. The resulting publication presented a framework for achieving better health and well-being, high-value health care, and strong science and technology for the nation. As an extension of the Vital Directions for Health and Health Care initiative, we turn our attention to the all-important state level, beginning with a symposium in North Carolina.