Health reform has created a watershed moment for community health workers (CHWs). Both coverage expansions and a new focus on creating value in health care offer new opportunities for CHWs. This paper assesses existing impediments to and enablers of the expansion of CHW employment. It catalogues how the ACA and other health reform efforts affect prospects for sustainable employment for CHWs. It also looks at workforce issues, insurance enrollment needs, affordability and accessibility of services, and changes in approaches to public health and prevention. The paper concludes by highlighting particular promising opportunities for CHWs in both public and private sectors.