Peer support arrangements involve peers without disabilities providing academic and social support to students with severe disabilities (i.e., students eligible for their state's alternate assessment) in general education classrooms. We conducted a systematic literature review of studies published through 2016 to determine whether peer support arrangements meet Council for Exceptional Children (CEC) criteria as an evidence-based practice. From our review of 11 studies, we found that peer support arrangements are an evidence-based practice for promoting social interactions for secondary students with severe disabilities in both core academic and elective classes. Evidence for increased academic engagement of students with severe disabilities is mixed, and evidence for other outcomes is promising--including increased academic engagement for peers who provide support. We provide recommendations for teachers.