College administrators are undercounting students who are hard of hearing in part because many do not ask for special services. Other professionals are concerned that these students are being underserved by state Vocational Rehabilitation (VR) agencies. This article presents a cross-disciplinary description of some complex factors contributing to these adverse patterns and multifaceted solutions needed for developing comprehensive VR and Disability Support Services (DSS) programmatic initiatives to better serve this “invisible student population.” A social psychological model of adjustment to hearing loss is described as are typical student case files. Specific VR and DSS managerial and staff roles in students’ transitions from high school, recruitment, acceptance of hearing loss, and college persistence as well as critical components of high-quality programming are discussed. The paper includes comments made by conference session participants.