Cleft palate is a common cause of velopharyngeal dysfunction (VPD); however, there are other conditions that can negatively affect the structure and function of the VP mechanism. These etiologies can arise from anatomical, neurological, and/or behavioral etiologies that constitute different cases of VP insufficiency, VP incompetence, and VP mislearning, respectively. The speech and resonance characteristics of individuals with non-cleft VPD may be similar to those with cleft palate. Craniofacial professionals who evaluate and treat individuals with non-cleft VPD need to be aware of these variations to ensure accurate diagnosis and appropriate treatment planning. This chapter discusses different types of non-cleft VPD and includes strategies for evaluation, differential diagnosis, and treatment decision-making where appropriate.