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The precisionFDA Truth Challenge V2 aimed to assess the state of the art of variant calling in challenging genomic regions. Starting with FASTQs, 20 challenge participants applied their variant-calling pipelines and submitted 64 variant call sets for one or more sequencing technologies (Illumina, PacBio HiFi, and Oxford Nanopore Technologies). Submissions were evaluated following best practices for benchmarking small variants with updated Genome in a Bottle benchmark sets and genome stratifications. Challenge submissions included numerous innovative methods, with graph-based and machine learning methods scoring best for short-read and long-read datasets, respectively. With machine learning approaches, combining multiple sequencing technologies performed particularly well. Recent developments in sequencing and variant calling have enabled benchmarking variants in challenging genomic regions, paving the way for the identification of previously unknown clinically relevant variants., Competing Interests: DECLARATION OF INTERESTS C.B. is an employee and shareholder of SAGA Diagnostics AB. A.C., P.-C.C., A.K., M.N., G.B., S.G., and H.Y. are employees of Google, and A.C. is a shareholder. S.D.-B., D.K.-Z., D.T., Ö.K., G.B., K.N., E.A., R.B., I.J.J., A.D., V.S., A.J., and H.S.T. are employees of Seven Bridges Genomics. O.S. and S. T.W. are employees of DNAnexus. G.L., C.M., L.T.F., Y.D., and S.Z. are employees of Genetalks. V.J., M.R., B.L., C.R., S.C., and R.M. are employees of Illumina. S.M.E.S. and M.M. are employees of Roche. C.H. is an employee of Wasai Technology. H.F., Z.L., and L.C. are employees of Sentieon.