This chapter explores the theory and practice of Business & IT Alignment in multinational companies. In the first part of the chapter an overview of the theory is presented. In this part the familiar frameworks for Business & IT Alignment are put in perspective in an Alignment development model. The second part of the chapter presents the practical issues that are experienced in aligning IT to business in multinational companies. These issues and considerations resulted from a focused group discussion with IT managers and CIOs of medium sized and large organizations in the Netherlands.