Many patients with acute pulmonary embolism (PE) are low risk for PE-related mortality and eligible for outpatient management. Validated clinical decision tools exist to assist providers in selecting candidate patients based upon risks of PE-related adverse events, bleeding events related to treatment, and social factors that would preclude outpatient management. Although recommended by several major society guidelines, outpatient management of patients with acute PE is underutilized. Advances in therapeutics (direct oral anticoagulants) and favorable results from implementation trials of outpatient management may encourage more physicians to avoid hospitalization for eligible patients with resulting benefits in patient safety and cost metrics. Pregnant patients and those with concurrent cancer are at higher risk. Best-practice for outpatient management of these special patient populations is evolving.