State departments of transportation (DOTs) are encouraging early involvement of contractors in highway design and construction through the solicitation of alternative technical concepts (ATCs) during procurement. This approach provides DOTs with the opportunity to tap industry experience and expertise for design alternatives. ATCs can improve constructability, enhance innovation, shorten schedules, reduce risk, and ultimately save costs. DOTs have documented significant cost savings from ATCs on a project-by-project basis. This paper provides an up-to-date perspective on the types of projects in which ATCs are used in U.S. highway construction, according to empirical data from a national study of 250 projects completed by DOTs and the Office of Federal Lands Highway. These projects were completed through design–build, construction manager–general contractor, and design–bid–build project delivery methods, and only 40 of the projects solicited ATCs during procurement. The quantitative findings presented in this paper were facilitated by the use of the project information from the national study and complimented by an extensive literature review on the use of ATCs in the U.S. highway construction sector. It was found that DOTs used ATCs on 51% of the 70 design–build projects procured by best-value selection in the study. Given that only 2% of the 116 design–bid–build projects and 5% of the 38 low-bid design–build projects in this study used ATCs and that no construction manager–general contractor projects used ATCs, there appears to be an opportunity to capitalize on the benefits of ATCs in projects using those delivery methods.