In this article, we review translation, adaptation policies, and practices in providing test accommodation for English language learners (ELLs) in the United States. We collected documents and conducted interviews with officials in the 12 states that provide translation accommodations to ELLs on content assessments. We then summarized challenges to ensuring fair and valid accommodations to ELLs and provided recommendations to address the challenges involved in translating a content test while preserving its validity.