Needs assessments can be a pragmatic method to shape interventions addressing gender-based violence. They are complex endeavors even—or especially—at the local level (e.g., rape crisis centers, domestic violence shelters). Focusing on the US context, we highlight examples of the ways needs assessments can support the gender-based violence movement, and key tensions and considerations within needs assessment practice. We explore decisions that practitioners make when pursuing needs assessments and highlight conceptual and design considerations. We also provide a general discussion of needs assessment approaches. This paper aims to support nascent practitioner and researcher/evaluator work in gender-based violence needs assessments.