The article aims to explore the following question: "How is education for sustainable development and health education in schools approached and contextualized at a municipal level, and what contradictions and tensions might local structures imply for sustainable health promoting school development?" Based on interviews with key agents at the municipal level in Denmark and drawing on a knowledge exchange network, the article identifies and discusses the following three themes across education for sustainable development and health education: (i) autonomy, engagement and ownership; (ii) open frameworks and invitations to "run with the ball"; and (iii) ad hoc professional development. A main conclusion in the article is that local approaches are largely based on plurality and voluntarism, and are formed around enthusiasts. There is a risk that this framework becomes so flexible that it "falls apart" in the balance between rigidity and flexibility.