Most Christian universities support a traditional view of human sexuality. It is uncertain if they can survive with their religious identity intact, given the rapid increase in societal acceptance of same-sex marriage. The 2015 Obergefell v. Hodges decision legalizing same-sex marriage increases pressure to be more affirming. Thirty-four presidents at universities in the Council for Christian Colleges and Universities (CCCU) participated in a survey, and twelve were interviewed to explore their perceptions regarding that pressure and potential responses. The study was framed by institutional isomorphism theory, and data were analyzed using basic qualitative research methods. The results show that coercive isomorphism is the strongest mechanism, with current pressure to conform emanating from state and federal government.Regional variance is considerable as institutions in the South report little pressure while those in blue states like California report strong local pressure. It is experienced in actual or implied threats to remove student access to state and federal financial aid and eliminate tax-exempt status at universities that discriminate based on sexual orientation. Liberal voices within the Church, accrediting agencies, LGBT advocacy groups, and changing student values are other sources of pressure. Universities seek compromise solutions but are prepared to mount a legal challenge based on the Free Exercise Clause of the First Amendment. They are not prepared to deal with changing student values, the strongest long-term source of pressure. To withstand pressure to conform, Christian universities must craft a unified response; find alternative sources of funding; engage and educate their boards; and find a way to assure young people that it is possible to be kind and loving while holding non-affirming policies related to same-sex marriage.