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This paper explores the link between new immigration to Colorado mountain communities and public health service delivery from a comparative perspective. It utilizes a combination of original survey data and key informant interviews, with county commissioners and health providers in both Lake and Eagle Counties of Colorado, in order to examine how disparities in access to services across sub-populations translate into health outcomes. Specifically, we argue that an emerging “social ecology” of Colorado mountain regions distinguishes employee-housing communities from resort communities, augmenting disparities in services and deepening the structural exclusion of minority immigrant communities from adequate healthcare. In particular, more affluent Eagle County extracts services from a low-wage workforce without the attending healthcare costs, with important ramifications for both immigrant labor health outcomes and community infrastructure in neighboring Lake County. This paper builds on previous work exploring environmental racism in Colorado and the structural violence of ethnicity and public health, while also putting forth important policy recommendations for improved statewide public health in Colorado mountain regions.