An individual dairy cow’s productive life in the herd is determined by her health and the need for dairy producers to optimize the production of each individual within the herd for a duration determined by replacement availability. Within this system, several aspects of management and facility design impact the health and productivity of the cow. Comfort is maximized by optimizing resting behavior in freestall facilities to achieve approximately 12 h/d of lying time, through stall design and bedding management, by taking measures to cool the cow during periods of heat stress and by allowing sufficient time for rest. Recommendations exist to size the stall relative to the size of the cows using them and utilize deep loose bedding, particularly sand. Loose-bedded packs provide an alternative housing option. The management of heat stress involves implementing a program which provides fast moving air in each lying area (target 200–400 ft/min, 1–2 m/s), sufficient exhaust capacity to force heat, moisture and noxious gases from the barn (target 40–50 air changes per hour and 1,500 ft³/min, 2,550 m³/h per cow), designs which ensure that the system works as well in the winter as it does in the summer, and the strategic use of water to mist the air or soak the cow at the appropriate times to assist with cooling in the warmest climates. The time available for lying is influenced by pen sizes relative to parlor throughput or robot milker availability, and by management interactions such as health screening cows in headlocks at the feed bunk for prolonged periods. Resting behavior is also significantly affected by lameness. Sufficient space for access to feed and the design of the feed bunk appear particularly critical during the transition period and there is a need to minimize regrouping stress during this important period. Cows must move easily between feeding, drinking, milking and resting areas of the farm, making alley dimensions and flooring surfaces a critical element of design. Enormous strides have been taken to improve cow comfort over the last decade by developing facility design recommendations that merge structural requirements with the needs of the cow.