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Extreme heat is a growing concern for local governments due to climate change and urban heat island effect. While environmental policy and governance issues such as water and energy tend to be well-developed, heat studies and policies remain highly under-discussed and under-developed within the public policy and management community. In the U.S., Arizona and New Mexico, public health outcomes have deteriorated for decades. To address this concern, we surveyed county-level public managers in Arizona and New Mexico (n=44), who are on the frontline of addressing extreme heat. We asked them about their perceived impact, preparedness, governance arrangements, and the effectiveness of their heat mitigation and management efforts. To further examine heat preparedness and governance, we conducted in-depth interviews to identify underlying mechanisms and factors driving heat-resilient outcomes. Results suggest significant variations exist in counties’ levels of heat planning and policies, with rural and remote counties having far fewer resources to prepare for heat. Public health remains the primary lens through which heat issues are approached and understood. While county managers tend to report a high perceived impact of heat mitigation and management measures, many counties have limited heat governance capacity to implement them. Interviews further reveals that rural regions face distinct and pressing heat-related challenges but often these communities feel marginalized or underrepresented in heat governance efforts. This research sparks a debate on how to balance heat mitigation and adaptation across urban and rural contexts within current governance landscape. The public policy and management community should pay far greater attention to extreme heat issues.