In response to an increasing demand for organic products, the number of certified organic dairy farms in the United States has increased dramatically over the last decade. The consumers and concerned citizens who are driving this demand report a desire to support agricultural systems that are perceived to be more sustainable, more natural, and have higher standards of animal welfare. Despite the perception that organic farms maintain high levels of animal welfare, the relationship between the 2 is not straightforward. The objective here is to review the current literature on the welfare of dairy animals in organic systems compared with conventional. The 2 systems clearly place different value on animal welfare concerns; conventional farms place greater emphasis on biological functioning and health, whereas organic farms place higher value on the animals’ ability to perform natural behaviors and live in a natural environment. In the United States, organic farms are required to provide animals with year-round access to the outdoors, including at least 120 d of access to pasture during the grazing season. Moreover, synthetic chemicals are restricted, including antimicrobials commonly used to treat ill animals on conventional farms. A reliance on naturopathic remedies leads to challenges when it comes to improving welfare for the individual animal, as organic producers have fewer treatment options and must make difficult decisions when dealing with ill animals. There is also concern regarding the efficacy of these naturopathic treatments, and little research to support their usage. Despite efforts to create preventative disease control strategies, the limited research available indicates that there is little difference in disease prevalence between organic and conventional systems. There are clear gaps in the literature evaluating the welfare of animals on organic dairy farms. Continued efforts are still needed to identify effective ways of preventing disease, and to develop effective naturopathic therapies to help reduce the number of ill animals and the duration of time that each animal is ill. A better understanding of how some organic farms are currently able to maintain low disease incidence could also provide valuable insight into ways forward.