Structural Health Monitoring (SHM) technology, as a commercial service, has been available for over a decade, yet very few US State DOTs have adopted the technology for deployment on a routine basis. When asked why, some DOT engineers often cite lack of budget. Others cite uncertainty about how to procure the services effectively. Several engineers have voiced concern over application appropriateness, in other words, how and when to best deploy technology solutions for assessment of specific structural issues. It is rare that State DOT engineers express concern for return on investment (ROI), although that should be of primary interest to them. For purposes of this paper, it’s worthwhile to define what full-scale adoption of SHM means to users and service providers. This author believes it can be defined by a combination of the following situations: (1) Owners routinely consider its use for deficient structures; (2) Owners’ procurement practices for SHM are defined; (3) Owners can describe what system functionality they need for most situations; (4) SHM is discussed in the context of providing financial benefits, e.g. an expected ROI; and (5) Owners can readily identify the most reliable and cost-effective SHM commercial suppliers. Given the current and expected future Federal, State and local government transportation funding challenges and the continued deterioration of bridges large and small, it’s no surprise that bridge preservation has become a hot topic for practitioners. Yet this “hot topic” has not led to vigorous SHM adoption and deployment. The key question all State DOTs should be asking is this: “If we can’t afford to repair or replace a bridge, how can we ensure its continued safe use?” This paper will explore the practical issues surrounding the use of SHM technology as an answer to that question and provide specific recommendations for accelerating its adoption and deployment.