Peer-mediated approaches have been used for years to improve the academic behaviors of students, especially those with disabilities. The most systematized and well researched of the peer-mediated approaches relates to peer tutoring systems, which include specific elements of training, implementation, and evaluation. The purpose of this article is to distinguish peer tutoring systems from incidental tutoring approaches, document the application of peer tutoring within academic and specialized areas (e.g., music or horticulture), show representative examplars of data-based studies that provide varied applications from preschool to secondary levels across a range of students with and without disabilities, suggest adaptations to the system, and offer recommendations for future research.