This study explores the variation in state vocational rehabilitation agency practices with youth with disabilities transitioning to adulthood. It uses a case study approach for a select group of eight agencies—five of which had statistics for their youth applicants that indicated relatively higher transition outcomes compared with all agencies and three of which that did not. The study examined organizational and collaborative strategies; outreach, application, and eligibility; service delivery; employment; and monitoring and evaluation. Among the findings, eight agencies had many similarities in how they identified youth with disabilities and provided services to them, such as having staff dedicated to serving youth and having programs targeting youth, often in conjunction with one or more community partners. We also observed several differentiating features among agencies with high or low transition outcomes, some of which are less under an agency's control and others that are within an agency's control.