This paper outlines a summary of seven trends relevant to providing sustainable primary care practices support. It also provides an overview of the evidence regarding the effectiveness of external practice support in improving process and health outcomes in primary care. Three case studies of prominent practice support programs are featured, with a focus on how these programs have sustained funding and infrastructure in a changing environment. Finally, recommendations are provided to practice support program leaders for maintaining financially and strategically viable programs as the U.S. health care system, and specifically primary care practices, move through a time of significant change.