Since the first review of alternate assessment literature by Browder, Spooner, Algozzine, et al. (2003), educational research related to alternate assessment has rapidly expanded as state and federal policies have required the inclusion of students with disabilities, including students with the most significant cognitive disabilities, in state and school accountability indexes. The purpose of this literature review was to examine the empirical studies conducted since the conception of alternate assessment to evaluate the progress made in this area, using a research framework proposed by Browder et al. We discuss future research directions, particularly as these relate to recent changes in federal policy under No Child Left Behind as well as implications for teachers and practitioners.