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Mobile stroke units (MSUs) are a major advancement in prehospital stroke treatment. Compared to standard care, current evidence shows MSUs are able to deliver intravenous alteplase faster, have higher rates of intravenous alteplase administration, and transport patients more often to appropriate levels of care. Though still in its early stages, prehospital stroke assessment with a MSU is becoming more widely recognized as an efficient, feasible, and integral component of acute advanced stroke systems of care. This chapter covers important concepts in the advent and growth of MSUs including time-based treatment benefit, clinical process efficiency, application of telemedicine, imaging capabilities, transport destination and triage, cost effectiveness, and clinical outcomes.