The Behavioral Risk Factor Surveillance System (BRFSS) is a large state-based telephone survey. BRFSS is designed to monitor the leading risk factors for morbidity and mortality in the United States at the local, state, and national levels. The BRFSS has proven to be a powerful tool for building heath-promotion activities. However, the use of telephone-based, random-digit-dial (RDD) methods in public health surveys and surveillance is at a crossroads. Rapid changes in telecommunication, declines in participation rates, increases in the required level of effort and associated costs are becoming key challenges for BRFSS. To maintain the highest data quality and service to the local and state health departments, BRFSS has adopted an ongoing effort to improve coverage and response to the survey. This article provides an overview of the issues faced by BRFSS and the strategies in place to address them.