This article examines why major reforms so often disappoint. It starts with an explication and analysis of perspectives for understanding why reforms often do not work out as hoped—rational comprehensive decision making and garbage can decision making, the latter in a “pure” version and in a modified version of the garbage can widely identified with the work of John Kingdon. We present these perspectives in a general way and then discuss how we can understand features of two central aspects of reforms based on these perspectives—the processes leading up to decisions on reforms and reform implementation processes. Some brief case studies are presented to illustrate some of the problems laid out in the theoretical part of the article. We conclude that nonincremental reform is vulnerable at every stage from conception to implementation and that although reforms are certainly not always doomed to failure, they are not often great candidates for success either.