North Carolina hosted the 2018 FEI WEG in Polk County at the Tryon Equestrian Center in September 2018. Polk County, located in the Mountain region of Western North Carolina, is home to 20,357 people, and the population is widely distributed. Event organizers expected approximately 300,000 to 500,000 people to visit the area, with 800 horses from 71 countries taking part in the games. Providing adequate public health epidemiologic investigations and response for the large scale event in the predominantly rural area presented a challenge.