Diseases continue to be important constraints in wheat and barley conservation cropping systems in the semiarid Pacific Northwest. Several diseases are more damaging in highthan low-residue seedbeds, and in crops planted during early autumn to reduce soil erosion during winter, especially unirrigated winter wheat in rotation with summer fallow in low rainfall zones (250–400 mm). Changes in cropping systems in the region have made disease management and maintenance of yield goals and farm profitability more challenging because disease management often is more complex and expensive with conservation tillage than inversion tillage. Practices being developed to meet this challenge are reviewed for diseases that are particularly trouble some in conservation farming systems of the Pacific Northwest.