Adolescents who struggle with reading face persistent academic and social challenges that extend beyond the classroom. Despite decades of research and reform efforts, national assessment data reveal stagnant reading achievement among middle and high school students. This article argues for renewed attention to reading instruction with adolescents, particularly for those whose literacy skills remain below foundational thresholds. Drawing on a case study of 152 high school students receiving intervention in San Diego, the authors highlight the significant gaps in decoding, vocabulary, fluency, and comprehension that hinder progress. The paper examines historical approaches to adolescent literacy, including content area and disciplinary literacy, and explains why these strategies often fall short for the most struggling readers. Instead, the authors call for interventions that explicitly address four critical areas: self-efficacy, background knowledge, decoding, and word knowledge. Evidence from research syntheses suggests that such interventions can produce meaningful gains when instruction is responsive to students’ profiles and when texts are appropriate for adolescents’ developmental levels. Ultimately, the case is made for systematic, intentional reading instruction in secondary settings to ensure equitable opportunities for academic success and lifelong literacy.