The rapid spread of natural gas fracking across the U.S. has given little time for scientists, local communities, and government to react. The point of this essay is to make sense of the emerging data and literature on environmental health risks posed by hydraulic fracturing to determine what the risks are, which ones matter to these communities, why they matter, and how they are reflected in national policy by using Washington County, Pennsylvania as a case study. Examination of interdisciplinary evidence shows that residents of Washington County have created a hierarchy of risks that places an emphasis on water quality despite inconclusive scientific evidence on the magnitude of environmental health risks posed by hydraulic fracturing due to local news coverage that focuses almost exclusively on water-related issues. It is posited that this biased reporting is the result of the legal infrastructure in place in Pennsylvania prior to natural gas fracking that provided for greater monitoring of water as opposed to air pollution from natural gas. Regardless of the scientific accuracy of Washington County’s risk perceptions, they do not appear to be included in national fracking policy.