Incumbent Rep. Valerie Foushee (D) defeated Nida Allam (D) and Mary Patterson (D) in the Democratic primary for North Carolina's 4th Congressional District on March 3, 2026. As of March 2026, Foushee and Allam led in endorsements, fundraising, and local media attention.

The primary was a rematch between Foushee and Allam, who ran for the then-open seat in 2022. Foushee defeated Allam 46%–37% in 2022. The 2026 primary took place in the context of redistricting in North Carolina. The redrawn 4th District's boundaries differed from those established following the 2020 census and used in the 2022 election. According to The Assembly's Chase Pellegrini de Paur, "Of the roughly 40,000 votes that Foushee won in 2022, about 22% came from areas no longer in the district. The changes affected only about 5% of Allam’s voters."

Rep. Jim Clyburn (D), EMILY's List, and the Congressional Black Caucus Political Action Committee endorsed Foushee. Sen. Bernie Sanders (I), Our Revolution, and the Sunrise Movement endorsed Allam.

Pellegrini de Paur wrote that the candidates' "voting records likely wouldn’t differ dramatically...they are also radically different in their approach to politics. Allam has an aggressively pro-worker message and a penchant for TikTok trends and selfie-style Instagram videos. Foushee is a measured, 69-year-old stateswoman and the highest-profile member of a local political dynasty." Writing in The Duke Chronicle, Lila Cohen and Sarah Diaz said Foushee "highlighted the experience she has gained over her years in public service and stressed the urgency of the current political climate." The News & Observer's Kyle Ingram said Allam "has positioned herself as an anti-establishment figure who argues that mainstream Democrats have failed to mount a meaningful resistance to Trump."

In an interview with the Duke Chronicle, Foushee said: "What probably has helped the most [to prepare for this role] is serving at the local level — having served on the school board ... and as a county commissioner, understanding what the needs of a community are." In a statement, Allam said she was "running for Congress because in a moment when our community faces dueling crises of Republican authoritarianism and corporate billionaire greed, we need leaders in Washington who will actually fight to deliver the brighter future we deserve and desperately need."

Foushee was a former administrator with the Chapel Hill Police Department who served for 15 years in local elected positions and 10 years in the North Carolina General Assembly before her election to Congress. Allam was, as of the 2026 elections, an organizer and the vice chairwoman of the Durham County Board of Commissioners.

As of March 2026, major election forecasters rated the general election Safe/Solid Democratic.