Since before statehood Alaskan communities have been plagued with widespread alcohol related crime, violence, health issues, and death. The “local option” approach to addressing access to alcohol in Alaska became law through Title 4 of the Alaska Statues in 1981. “Local option” communities may exercise a local option to modify the State laws regarding alcohol importation, sales, and possession for their own community. Becoming a “local option” community is voluntary but an overwhelming majority of “local option” communities are rural and have a predominately Native population. In 2009, one of the “local option” communities voted to end its “local option” status. This case study provides a framework to examine the cultural, political, commercial, social, and health issues related to alcohol use in rural Alaska.