The desire for a realistic exercise scenario can lead to the development of tabletop exercises around scenarios rather than issue areas based on local preparedness needs and priorities. This does not ensure that the participants will address the important issue areas. A broad mix of challenges related to a given scenario must be addressed, often simultaneously, ranging from conducting epidemiologic or environmental investigations, implementing and modifying interventions as information becomes available, communicating within and across agencies, and communicating with political leaders and the public. Introducing this full set of tasks into an exercise scenario in a way that meaningfully exercises relevant capacities is unlikely to align with the exercise's objective. Moreover, different stakeholders may want to address different issue areas and may become frustrated if their expectations are not met. It is therefore important for stakeholders to agree on a limited number of priority issue areas for the exercise and then to focus the design of the scenario around these areas.