Since 2005, the Thomas B. Fordham Institute has published annual analyses of Ohio's state report card data, focusing on district and charter schools in Ohio's Big Eight urban areas: Akron, Canton, Cincinnati, Cleveland, Columbus, Dayton, Toledo, and Youngstown. For the 2017--18 school year, we provide an overview of Ohio's assessment and report card framework along with an examination of key academic data from 2017-18 state exam results and other indicators of post-secondary readiness. The diagnosis is stark: (1) On 2017-18 state exams, only 36 percent of Ohio students meet the state's college-and-career ready (CCR) benchmarks in math, and 38 percent do so in English language arts. Low-income students fare even worse in reaching CCR targets: Just 22 and 24 percent of economically disadvantaged pupils reach CCR levels in math and English language arts, respectively. The CCR target is based upon reaching the accelerated or advanced levels on state assessments, and is designed to give a better indication as to whether students are on pace for success in college and career. (2) In the graduating classes of 2016 and 2017, just 26 percent of Ohio students meet the state's remediation-free targets on the SAT or ACT exams. In six of Ohio's Big Eight districts, less than 10 percent of students earn remediation-free scores (Akron and Cincinnati being the exceptions). Set by the Ohio Department of Higher Education, achieving remediation-free scores allows incoming college students to take credit-bearing (non-remedial) courses. (3) Based on data from the classes of 2016 and 2017, 4 percent of Ohio students earn industry-recognized credentials that can open opportunities in technical careers. In six of the Big Eight districts, credentialing rates fall below 2 percent (Columbus and Dayton being the exceptions). Ohio's annual checkup reveals that roughly two in five Ohio students are meeting college and career ready goals, with even lower rates across its largest cities. Clearly, more treatment is needed if Ohio's students are going to leave high school poised for success in college or the workplace.