Accountability has become a primary function of large-scale testing in the United States. The pressure on educators to raise scores is vastly greater than it was several decades ago. Research has shown that high-stakes testing can generate behavioral responses that inflate scores, often severely. I argue that because of these responses, using tests for accountability necessitates major changes in the practices of educational measurement. The needed changes span the entire testing endeavor. This article addresses implications for design, linking, and validation. It offers suggestions about possible new approaches and calls for research evaluating them.