Since 1923, more than fifty countries have improved access to dental care by allowing midlevel providers—frequently called dental therapists—to offer preventive and restorative treatment, primarily in the public sector. A growing body of research has found that dental therapists provide high-quality, cost-effective care and improve access to care for underserved populations. This article explores the evolution of the dental therapy movement in the United States, where multiple barriers to oral health care have created persistent unmet needs. We examine developments since the 1940s that have led to the authorization of dental therapists in parts of Alaska and the states of Minnesota, Maine, and Vermont; and the approval of national accreditation standards for dental therapy training programs by dental educators. We also show how dental therapists might fit within a health care system that is being transformed.