This review was conducted to synthesize current knowledge, learn producer and Extension specialist perspectives, and identify gaps in understanding of the role of soil health in sustaining production in high tunnel (HT) systems. This synthesis includes findings from scholarly resources related to soil health in HTs, including research and Extension-based literature, perspectives from experienced HT producers and technical assistance providers, and the direct observations of a broad network of university research and Extension personnel working with HTs. Findings are intended to identify knowledge gaps and additional research and Extension resource needs of greatest priority to the HT producer community and technical assistance providers that support them at the time of publication. A review of 68 research articles and 58 Extension resources was conducted. Focus group interviews were conducted with small groups of experienced HT farmers in four regions of the eastern half of the United States, with in-depth farm case studies conducted in individual farmers in three of these regions. Growers across regions identified soil fertility management, soilborne diseases, soil compaction, and lack of consistency of soil analyses specific to HTs as the greatest soil-related challenges to HT production. Research and resources for technical assistance providers on mitigation strategies to remediate yield-limiting HT soil conditions, such as excessive soil salinity and high pathogen populations, were also lacking. As such, process-based research on techniques such as leaching, soil steaming, solarization, and anaerobic soil disinfestation in tunnels that consider short- and long-term costs, benefits, and effects on soil and plant productivity should be prioritized in the future when considering the impact of HT production on soil health. Interviews also indicated a need for networking opportunities for technical assistance providers across agencies (e.g., Natural Resources Conservation Service, Extension, nongovernmental organizations). Despite a high and increasing rate of adoption, there is currently a lack of information about maintaining HT systems. Given that HTs play a critical and growing economic role for specialty crop growers throughout the eastern United States, comprehensive intervention across the research–Extension spectrum to sustain productivity in HT systems is recommended.