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Regionalism is defined in many ways. Some define it by regional tax sharing and consolidating local units of government into a larger city/county statutory governing arrangement that may encourage equity and efficiency. Notable examples of this include Indianapolis and its “Unigov” consolidation with many surrounding towns, municipalities; as well as the City of Nashville and Davidson County in Tennessee. Other consolidations are bilateral city-to-city policy setting arrangements, such as the Metro Council, that determine growth and development policy for the Twin Cities, Minneapolis-Saint Paul. This study proceeds on the belief that regionalism can also be defined in functional terms based on necessity and evolving trust among local governments. Using a survey of mayors and managers in Cuyahoga County, Ohio, we found there are bilateral and multilateral relationships that are growing based on an uncertain economic environment and declining intergovernmental support. What results from these growing functional relationships is unclear, but they do form the organic base for broader collaboration and cooperation.