While rates of tobacco use on university campuses rose over the past decade, little is known about what institutions are doing to address this rising concern. Health center directors at public institutions of higher education across the state of Texas were surveyed (n = 42) regarding the perceived importance of smoking cessation, prevalence of interventions on their campuses, and perceived success of intervening efforts. While most health center directors regarded smoking cessation as important, over half of the directors indicated that their sites did not offer tobacco cessation services of any kind. Furthermore, of those offering smoking cessation, most believed that their smoking cessation programs were only somewhat or not at all effective. Findings revealed that there is a noticeable gap between perceived importance and actual implementation of smoking cessation programs within university-based health centers. Recommendations include implementing innovative cessation methods, such as those that are Web-based and highly accessible to students.