There is new and growing interest in adolescent immunization. Since 2005, three new vaccines for older children have been licensed in the United States and recommended by the Centers for Disease Control and Prevention. Although the majority of 13–17-year-olds have received recommended vaccines, rates remain below 2010 targets, and the coverage rates for low-income adolescents and minority youth are likely to be lower. The authors discuss barriers to expanded adolescent immunization and develop recommendations to address those barriers. Some recommendations — such as creating concrete, actionable, and active messaging for adolescents and their parents and fostering school accountability for administering vaccines — can be accomplished within the existing legal framework. Others — such as making parental consent time-enduring and administering consent through a Web portal — have tremendous potential to improve coverage rates among adolescents and children but require modernization of current consent laws.