Augmentative and alternative communication (AAC) holds the potential to enable people with severe oral communication impairments to participate more fully in society. However, despite the development of increasingly sophisticated communication aids, as well as recent UK policy initiatives aimed at improving access to them, some major obstacles stand in the way of the inclusory potential of AAC being realized to any significant degree. Drawing on findings of a research study that explored the experiences of people who use AAC, this paper looks at the various problems that people encounter in using communication aids. It identifies the lack of consistent, structured support as a key overarching issue. The author goes on to argue that for the potential of AAC to be realized attention needs to be given to the development of coordinated systems of support within the policy domains of education, health and social services.