Research suggests that the severity of emotional, behavioral, and characterological concerns of college students has increased significantly since the late 1980's. There is also evidence of a student body that is becoming more diverse according to race and age. This paper presents data and summarizes findings in three areas: the increase of client severity; the increasing diversity of student populations; and the loss of resources that support clinical services. In addition, current effective practices in college clinical services are highlighted, and creative personnel and technical enhancements designed to stretch limited resources are proposed. This paper calls for a balance of thoughtful considerations of alternatives with both an eagerness to adapt to change and an eye to borrow from other settings and disciplines. (MKA)