Stroke has a marked impact on the ability to return to work. However, the stroke and its residual cognitive, physical and language deficits do not fully explain return-to-work success. While those with very severe deficits are less likely to return to work, and presence of disability is important, other extrinsic and intrinsic factors, such as having a job to go back to, beliefs and attitudes about work, job markets and the benefits system all play an important part. Vocational rehabilitation services developed with the stroke service user in mind are scarce in the United Kingdom. However, recent government interest in vocational rehabilitation and a recognition that evidence to support poststroke vocational rehabilitation is lacking have prompted efforts to develop new vocational rehabilitation services. People with stroke need specialist vocational rehabilitation services delivered by those who have an in-depth understanding of stroke and its effects. Service developers need to acknowledge and address factors that enable or impede return to work after stroke in service design. Research is needed to evaluate vocational rehabilitation interventions aimed specifically at the needs of stroke patients.