Although some home visiting programs have proven effective with the families they serve, no program has yet demonstrated broader impact on an entire county or state population. This article describes the Durham Connects program, which aims to achieve broad county-level effects by coalescing community agencies to serve early-intervention goals through a Preventive System Of Care and by delivering universal, short-term, postnatal nurse home visiting services. Evaluation of Durham Connects occurred through a randomized controlled trial of all 4,777 births in Durham, NC, over an 18-month period. The results indicated that, by 6 months old, Durham Connects infants had 18% fewer emergency room visits and 80% fewer overnight stays in the hospital than did control families. A broad effect is achievable if a program attends to the challenges of community partnership, universal reach and assessment, rigorous evaluation, and strategies for sustaining funding.