The creation of road infrastructure is a growing global activity. Given its major impact on climate change and health, road transport should be a strategic sector for HIA. But is it really? This chapter examines worldwide HIA practices on road infrastructure projects, analyses issues and challenges specific to this type of HIA and outlines future research prospects. First, a review of 22 HIAs shows that few assessments focus on road construction; most address road improvements or traffic mitigation. Then, a case study is presented: an HIA on a controversial French bypass project, highlighting methodological and political challenges. Findings emphasize the need for more standalone HIAs on road construction projects and for strengthening the health component in Environmental Assessments. Recommendations for practice and future research include creative methodologies, enhanced public participation, adaptation to power relations and a more holistic approach.