Cognitive impairment associated with schizophrenia is prevalent, persistent, and has strong implications for real-world functioning. Assessment of cognitive health needs is critical for creating a shared understanding of clients’ experiences and behaviors and sets the stage for collaborative, personalized treatment planning. Identifying areas of cognitive strength and relative need informs appropriate intervention and supports. Mental health services research has highlighted the complex challenges of obtaining assessments of cognitive health needs that are feasible, acceptable, and clinically informative in routine practice settings. It is useful to consider three types of assessments—screening, brief targeted assessment, and comprehensive evaluation—each with a unique purpose and associated challenges impacting implementation. A number of practical solutions are recommended to address these challenges, improve uptake of assessment practices, and better meet client needs.