Many educational organizations are trying to reduce the cost of exams, the workload, delay of scoring, and the human errors. Also, organizations try to increase the accuracy and efficiency of the testing. Recently, most examination organizations use Computerized Adaptive Testing (CAT) as the method for large scale testing. This chapter investigates the current state of CAT systems and identifies their strengths and weaknesses. It evaluates 10 CAT systems using an evaluation framework of 15 domains categorized into 3 dimensions: Educational, Technical and Economical. The results show that the majority of the CAT systems give priority to security, reliability, and maintainability. However, they do not offer to the examinee any advanced support and functionalities. Also, the feedback to the examinee is limited and the presentation of the items is poor. Recommendations are made in order to enhance the overall quality of a CAT system. For example, alternative multimedia items should be available so that the examinee would choose his preferred media type. Feedback could be improved by providing more information to the examinee or providing information anytime the examinee wished.