This study sought to develop an assessment tool to help health agencies enhance their capacity to provide sexually transmitted disease (STD) care to communities at risk and close the gap of racial disparities in health. Specifically, the study sought to (a) define the organizational competence of agencies serving communities at risk for STDs, and (b) develop a method to assess an agency’s organizational competence. In a rural Southern county, qualitative action research methods including key informant interviews, observation, and document review were used to assess four health agencies’ competence in responding to the needs of high STD-risk communities. Nine dimensions of organizational competence were identified: community participation, assessment of community needs, ensured access to services, community outreach, cultural competence, interagency collaboration, policy development, resource acquisition, and organizational commitment to serve. A competent organization was conceived as one that (a) is committed to serve, (b) works with communities at risk, (c) understands and appropriately responds to their needs, and (d) advocates on their behalf.