There is a small, methodologically diverse body of research indicating that approximately 20% of families provide disproportionate amounts of foster caregiving, place fewer restrictions on characteristics of children they are willing to foster and actually do foster, and provide caregiving environments as good as or better than those provided by other foster families. Cherry and Orme (2013) conceptualized this phenomenon in terms of the Pareto Principle, also known as the 80-20 rule or the Vital Few, and they refer to these 20% of families as the Vital Few and the remaining 80% as the Useful Many. This review will examine and synthesize the available research on Vital Few foster families and explore next steps in the development of this body of research.