Let's TalkLet's TalkThe largest and least uniform of the four markets we work in. Most of what makes it hard is that it is not one market at all.
Not the language and not the currency. The things that change how a campaign has to be built.
A dentist, a physician, a chiropractor and an optometrist practising in the same city answer to four different boards with four different advertising rulebooks. Agencies that learn one state's rules and apply them nationally get it wrong in both directions - permitting what is prohibited and refusing what is allowed. We have written the advertising rules for six boards across Texas and Florida and we treat each licence type as its own compliance question.
Cost per click for the same service in Austin, Jacksonville and Houston can differ enough to change whether a channel is viable. A national campaign optimised to a blended target quietly overspends in the cheap markets and gets outbid in the expensive ones. Budgets set against a state or national average are the single most common reason a US campaign underperforms for reasons that have nothing to do with the creative.
There is no single federal consumer privacy statute, so consent, opt-out and data-sale obligations vary by the state a visitor happens to be in. Practically, that means a tracking setup that is fine in one state can be non-compliant in another, and the safe architecture is the one that assumes the stricter rule rather than the one where most of your traffic lives.
Advertising regulation is the one part of this that does not transfer between markets, and it is where overseas agencies get it wrong.
Testimonials and endorsements must reflect the honest experience of a real customer, and a material connection between advertiser and endorser - payment, free product, employment - has to be disclosed clearly. That reaches influencer content and affiliate content, not only the reviews on your own site. It is also why we will not write testimonial copy for a client and present it as a customer's words.
Meta and Google will happily run an ad that a state board would sanction. The platform's approval is not a compliance signal, and the responsibility sits with the licensee rather than with the agency that wrote the copy. For regulated professions we establish which board governs the licence before any creative is produced, which is a step most agencies skip entirely.
The general standard is that an advertiser must hold adequate support for a claim at the time it is made. In practice the test we apply is simpler: if a regulator asked for the evidence behind a number on the page, could you hand it over the same day? If not, the number does not go on the page - which is why our own stat badges say what they are and say when a figure is a target rather than a result.
The same disciplines in every market. How they are applied is what changes.
Clinical and professional practices are the deepest part of our work. Every one of these has its own page.
Within the United States the regulator depends on the state as well as the licence. These are the ones we have written up.
Yes, and most of our healthcare work is US-based. What matters is not where we sit but whether the campaign respects the rules that bind the client, and those are set by the state and the licence rather than by the agency's address. We would rather be explicit about that than imply a local office we do not have.
It can, and for unregulated businesses it usually should. For regulated professions it gets more careful, because the advertising rules differ by state and by licence type - what is permitted for a Texas dentist is not identical to what is permitted for a Florida one. The structure we use keeps the offer and the mechanics shared while splitting anything the boards treat differently.
Per metro, against that metro's own economics, rather than against one national cost-per-acquisition target. Auction density and cost per click vary enough between US metros that a blended goal systematically starves the markets where you could win and overspends where you cannot. It is more work to report and it is the only version that reflects the business.
Texas and Florida so far, across thirteen and seven clinical verticals respectively, each with the governing board and its advertising rules cited rather than summarised. More are planned. If your state is not covered yet that does not mean we will not work there - it means the written research is not published yet, and we will do it before the campaign runs rather than after.
We build the tracking to the stricter standard rather than to the standard of wherever most of your traffic comes from, because a US audience is spread across states with materially different consent rules and the alternative is a setup that is compliant for some of your visitors. Specific obligations are a question for your counsel; what we control is that the implementation does not assume the most permissive case.
No pitch deck, no discovery call you have to sit through. Tell us the situation and we will tell you whether we can help.