As our state and nation face increasingly tight program budgets and more limited funding sources, collaboration has come to the forefront as a critical mechanism to promote health and well-being. The Collective Impact framework is an emerging approach to guide larger scale changes at a community or regional level. Through the establishment of 5 core tenants including establishing a backbone organization/central infrastructure, shared agenda, shared measurement systems, mutually reinforcing activities and continuous communication the CI framework advances the work of prior theorists and creates a foundation for health promotion. In this article we discuss the foundations of the approach and describe how the tenants are applied using examples from a case study of the Wilmington Collective Community Impact Study. Finally we reflect on the evidence to date for the CI approach and offer critical points of discussion to advance community-engaged programming in a small city.