The stroke system of care is undergoing significant evolution. There are promising data to suggest that with new technologies and approaches, primary prevention and community education will become easier and more accessible, and will allow people to have greater participation in their own healthcare. The evidence-based primary and comprehensive stroke center concepts have been translated into robust, rapidly growing certification programs. The continued dissemination of improved EMS routing protocols allows for better allocation of patients to stroke centers, even as we confront the challenge of further improving prehospital recognition of stroke. National quality improvement initiatives help to ensure that patients directed to stroke centers receive evidence-based treatment, which has resulted in improved stroke care and better clinical outcomes. In remote areas, the use of technologies such as telemedicine to extend the reach of vascular neurologists has resulted in increased administration of time-sensitive thrombolytic therapy and better patient outcomes, although greater efficiency within the stroke system will likely be needed to realize the potential benefits of endovascular therapy. System-level paradigms for aggressive medical management promise to lessen the burden of recurrent stroke. Finally, further integration of rehabilitation programs into stroke centers and coordination with community-based rehabilitation services is needed to ensure the best possible outcome for stroke patients.