This chapter summarizes the key insights provided by the international transportation PPP project case studies and cameos presented in Chapters 3, 4, and 5 of this report. This includes issues that often confront sponsors and providers of PPP projects overseas and the strategies used to address and overcome these potential impediments. The chapter also contains summaries of the results and lessons learned from the PPP case studies and cameos. It provides conclusions regarding the advantages and challenges of using PPPs for surface transportation capital projects; recommendations to enhance the potential to use PPPs to achieve more cost-effective delivery of transportation projects and operating services, and closing remarks regarding the important role PPPs can play in expanding the surface transportation program in both developed and developing countries. The chapter concludes with remarks regarding the use of this report, a companion report on U.S. PPPs, and a PPP Guidebook by both practitioners and individuals or groups interested in the application of PPPs to help address the fiscal and resource crises facing the surface transportation community.