Provider burnout is widespread and becoming more pervasive over time. Using the experience of the Heart of Virginia Healthcare (HVH) as a lens, this brief addresses the scope and impact of provider burnout, why states should care, and what states can do about it. HVH is one of seven regional cooperatives reaching 1500 primary care practices nationwide as part of the Agency for Healthcare Research and Quality’s EvidenceNOW initiative to advance evidence-based cardiovascular disease prevention. The experiences of primary care practices participating in the HVH cooperative point to a number of practice challenges contributing to burnout including issues related to scope of practice, payment reform, reporting requirements, and electronic health records. This brief outlines a range of strategies and policy options that states have for mitigating burnout, which threatens not only provider engagement, but patient outcomes.