Stakeholder engagement in a health impact assessment (HIA) is a way to involve communities in the decision-making process of a proposed project or policy. Research conducted on the proposed Wishbone Hill Coal Mine (WHM) in Alaska sought to identify if participants felt the stakeholder engagement process used in a recent HIA was able to respond to cultural differences and inequitable distribution of health impacts. Using a qualitative methodology, 12 interviews were conducted with individuals who participated in the WHM HIA. Results indicate that existing issues of trust between the general public, Alaska Native peoples, and the government impact how the findings of an HIA are received by stakeholders. Recommendations were developed from the research findings and are intended to support continued public trust in the use of HIA in the State of Alaska. Recommendations include ensuring HIA practitioner competencies when working with communities, and implementing transparent stakeholder engagement processes.