Public support for establishing school-based health centers has outstripped understanding of how to pay for them in the long term. As a result, a large number of school-based health centers have been started without a clear notion of how they will be sustained. Since 1990, the number of school-based health centers has grown from an estimated 200 to almost 700. A substantial portion of these centers face staffing and service cuts if stable funding mechanisms to support school-based health centers are not put into place. This article addresses issues raised as state governments and the centers consider the possibility of patient care revenue as a component of a long-term funding strategy.