The new health reform law marks both the greatest advance for health centers in their entire 45-year history and their most significant challenge. The new, guaranteed funding provided – $11 billion over the next 5 years – should support the expansion of health centers to serve 20 million additional people by 2015, effectively doubling their size. However, in order to do that, they will need to recruit at least 14,000 primary care providers – physicians, nurse practitioners, physician assistants – plus additional thousands of oral health and mental health professionals. They face this considerable task amidst an already severe shortage of primary care clinicians; and even if successful, tomorrow’s health centers will be expected to manage a more rapid growth curve than they have ever experienced before, without losing their financial or organizational stability. Finally, health centers must determine how best to form integrated service networks with other local providers without losing those features – such as community ownership – that have contributed to their historic success and achievements. Follow their progress at http://www.nachc.com/healthreform.cfm.