The last two decades have seen significant changes in organizational structures within higher education. Counseling centers are no exception and have been the target of reorganizations and mergers that often involve student health services. Outcomes of these efforts have varied; some being quite successful while others have resulted in failures and the re-creation of systems that are remarkably similar to the ones that existed in the first place. An examination of the positive and negative issues relevant to mergers and reorganizations of counseling centers can be helpful in the determination of whether or not to proceed with one. In the event the decision is made to proceed, a systematic process that encourages consideration of essential steps relevant to mergers or reorganizations can promote improved decision-making and outcomes.