Any hearing loss can affect communication, but listeners with severe loss face the greatest challenges. For those listeners, speech is less audible, more distorted, and more susceptible to background noise. How should we address the needs of listeners with severe and profound loss? Our recent collaboration, the Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss represents an international effort by experts in diagnostic audiology, hearing aids, cochlear implants, and psychology to provide clinical guidance for treatment of severe and profound hearing loss. The Guidelines cover assessment, hearing aid fitting, assistive devices, bimodal devices, and psychosocial considerations, along with a comprehensive review of supporting evidence. That paper was the most accessed article for Seminars in Hearing in all of 2020 (!).We think this reflects the importance, interest and commitment of audiologists to treatment of severe loss.