Resource extraction and development projects alter community health and well-being in complex and diverse ways. The extractive industry’s impacts on local infrastructure and services are commonly recognized social externalities, yet little detail is available on how these manifest across the healthcare system. This study offers a better understanding of the health service impacts of resource extraction and development. It does this by capturing the observations and experiences of leaders from a rural, regional health authority who have worked with industry to manage impacts on health services during a period of rapid economic development and amidst the COVID-19 pandemic. The study found that impacts from resource extraction and development were experienced first and foremost in emergency departments but were also felt across the entire healthcare system. These pressures were primarily driven by the size of the temporary workforce but also influenced by factors such as the relative size of the workforce to the local community, the local context, and how well impacts were managed at the project level, including the competency of a project’s medical service provider.