Cross-jurisdiction resource sharing is considered a possible means to improve efficiency and effectiveness of public health service delivery. A merger of the tuberculosis (TB) clinics of a rural and a metropolitan jurisdiction in East Tennessee provided an opportunity to study service provision changes in real time. A mixed methods approach was used, including quantitative data on latent TB treatment outcomes and qualitative data from staff interviews, as well as documentation of changes in staffing time in TB services. Results showed a mix of efficiency changes, indicating probable increased pressure on key service providers after the merger, in addition to expected improvements of economies of scale such as a reduction in overall staff time. Mechanisms found beneficial in coping with the merger, such as face-to-face meetings between coworkers and management of the different jurisdictions were identified at interview. The clinic merger was associated with a balance of efficiency changes, problems and advantages, and this balance is likely to change as new working arrangements become more routine.