With nearly 2 million college-educated immigrants and refugees in the United States unable to fully utilize their professional skills, better understanding of the elements of successful programs and policies that reduce the waste of advanced education and skills can benefit immigrants, their families, and the U.S. economy more generally. This report explores a range of frontline programs and policy reforms that are providing cutting-edge career navigation, relicensing, gap filling, and job search assistance for foreign-trained professionals in a wide range of occupations. It also examines different state policy and licensing contexts that affect these highly skilled individuals, with a focus on the dense thicket of state laws and regulations that slow or prevent qualified individuals from practicing in a wide range of occupations. After identifying key challenges facing those working to end skill underutilization (also known as "brain waste") for highly skilled immigrants educated abroad, the report offers a number of recommendations, including: (1) Expanding initiatives to review and reform state licensing laws that impose unnecessary and undue requirements on foreign-trained immigrants; (2) Increasing advanced English language and bridge programming to help internationally educated immigrants top-off their skills and become licensed in the United States; (3) Conducting large-scale, formal evaluations of programs that support effective labor-market integration of high-skilled immigrants and refugees, and analysis of the elements of adult education and workforce training systems that contribute to their success; (4) Increasing monitoring and technical assistance to address employer bias; and (5) Expanding reciprocity and mutual recognition agreements, and support efforts to harmonize qualifications across countries, states, licensing boards, accreditation bodies and educational institutions.