This chapter provides a systematic analysis of the links between intelligent tutoring systems (ITS) and multimedia, and identifies the multimedia elements that are used by different ITS applications. It discusses the implications of ITS findings for cognitive theory and instructional design, identifies limitations of existing research, and provides some directions for the future. Problem-solving tutors typically use a mixture of text and graphic media. Simulation-based ITS remain popular, particularly for tasks that are tightly linked to an operational environment, such as power plants, aviation, or military exercises. Game-based tutoring systems make use of the widest range of media to present content, especially those that combine elements from natural language tutors and simulation-based tutors. Research on advanced learning environments has investigated multimedia factors that have obvious links to deeper levels of cognition, such as feedback, learner control, and generation of information, interactivity, reflection, animation, simulation, and affect.