The National Animal Health Monitoring System conducted national dairy studies in 1996, 2002, 2007, and 2014. In all 4 studies, information regarding milking procedures was collected via face-to-face interviews. Although the states participating in each study varied slightly, the goal for all the studies was to account for close to 80% of dairy operations and 80% of dairy cows in the US. An objective of this study was to describe how milking facilities and practices have changed over the last 18 years. In 1996, the average herd size on US dairies was 70 cows, and by 2014 herd size had more than doubled to about 160 cows. During this time, the average bulk-tank somatic cell count decreased from 300,000 to approximately 200,000 cells/mL. Although the majority of operations (52.8%) still milk cows in a tie stall or stanchion barn, parlor use increased from 28.8% of operations in 1996 to 45.7% in 2014. In 1996, 54.9% of cows were milked in a parlor compared with 86.0% in 2014. Although the percentage of operations that milked cows twice daily has remained around 90% since 1996, the percentage of operations that milked 3 times per day nearly doubled from 5.8% in 1996 to 10.2% in 2014. Glove use during milking has almost doubled at both the operation level (32.9% of operations in 2002 and 59.1% in 2014) and at the cow level (48.7% of cows in 2002 and 87.9% in 2014). Forestripping all cows has increased from 44.5% of operations in 2002 to 71.5% in 2014. From 1996 to 2014, compounds containing iodine were the most frequently used pre-milking and post-milking teat disinfectants. Automatic take-off use increased from 36.0% of operations in 2002 to 49.1% in 2014, while operations using a backflush system has remained between 6 and 7% since 2002. The US has seen an increase in dairy herd size over the past 18 years, and this increase is associated with more cows being milked in parlors, more operations using gloves and checking for mastitis via forestripping, and an improvement in milk quality, as evidenced by lower somatic cell counts.