Across the nation, the final stage of school restructuring is being reached by an inexorably increasing number of schools. Under the No Child Left Behind law, if a school does not make its adequate yearly progress targets after four previous years of being “in need of improvement,” it must implement a fundamental restructuring plan. The restructuring options are as follows: (1) turn the school operations over to the state, (2) turn the operations over to a private company, (3) reopen as a charter school, or (4) reconstitute the school by replacing some or all of the teachers, staff and administrators. There is a fifth alternative of applying “any other” fundamental school restructuring, an option now receiving new attention. It is essential that we know how these restructuring options work in practice -- particularly as the law is now due for reauthorization. This brief reviews the independent research on the ultimate sanctions and provides recommendations designed to enhance school improvement.