Many individuals use computer-based assistive devices as alternatives for the fluent, automatic skills of speech, writing, and touch-typing. This paper proposes that controlling an alternative access technique should become as automatic as touch-typing or speech. The process of acquiring a cognitive-motor skill is discussed. Prerequisites to skill acquisition and impediments to motor automaticity are outlined. Factors that promote or impede skilled control of alternative computer access systems at each stage of the design, assessment, prescription, training, and evaluation process are reviewed. Several case examples are used to illustrate relevant issues.