Heartland Tobacco War chronicles the political and public relations battles between health advocates and forces supported by the tobacco industry in Oklahoma from the 1980s to the present. Michael S. Givel and Andrew L. Spivak draw on previously-suppressed tobacco insider documents and first-hand interviews with key players in the conflict. This story of pro- and anti-tobacco lobbying and legislation in the nation’s heartland especially highlights the unique role of Oklahoma’s “renegade” Department of Health Commissioner, Dr. Leslie Bietsch. After decades of political dominance by the tobacco industry, this single maverick bureaucrat in the early 2000s bypassed the usual insider politics of the legislature and employed aggressive public campaign strategies to bring about sweeping legal victories for clean indoor air and tobacco taxes in a very conservative state. The authors examine the Commissioner’s aggressive advocacy in the context of insider and outsider policy advocacy, public administration ethics, the politics of bureaucratic activism and administrative lawmaking, and direct democracy. Heartland Tobacco War tells a story that will be of great relevance to public health practitioners, historians, health activists, health policy scholars, sociologists, public administration scholars, social movement and public interest group scholars, political scientists, public policy scholars, and anyone else interested in the politics of the tobacco industry.