There are many guides written for developing strategies and tactics related to advocacy, and many pages of text are devoted to developing advocacy plans. Less well described is the context within which grassroots advocacy campaigns can be successful. This article describes a successful campaign to establish a needle-exchange program (NEP) in Guilford County, North Carolina. The authors briefly describe NEPs in general, the history of NEPs in North Carolina, the mission of the North Carolina Harm Reduction Coalition (NCHRC), and why this approach was considered particularly important for Guilford County. Then the context of the successful adoption of an NEP in Guilford County and the progress to make it legal will be examined, including describing the specific advocacy activities facilitated by members of NCHRC. The article concludes with a discussion of lessons learned that may be applicable to other grassroots advocacy initiatives.