Background and Objective: This article compares the policy, care systems, and legislation surrounding acquired brain injury (ABI) in the United Kingdom (UK) and the United States (US). Consistent with their shared histories, many similarities in terms of culture, language, and politics, and their history of cooperative relations in military and diplomatic efforts, the US and UK have taken similar approaches toward meeting the needs of persons with ABI and their family caregivers. However, important distinctions exist. Method and Findings: Through a comprehensive narrative review, the article describes both common as well as distinct aspects of the system of ABI services from acute care through to long-term community rehabilitation. Conclusions: The article concludes by discussing areas of potential collaboration in research, services, policy, and training to advance best practice approaches in both nations.