In this study, a crisis of leadership succession led to greater subsequent pluralism by the previously less inclusive coalition. Substantial tension existed between both coalitions and the federally funded Appalachia Cancer Network, especially around its evidence-based mission. The fact that this tension occurred even at the more locally inclusive site indicates that pluralism may vary across levels within the same coalition. This article contributes to theory by exploring how coalitions evolve over time across community boundaries, as well as to management practice by yielding guidance about how to build inclusive organizations.