This chapter describes the philosophical underpinnings of pragmatic approaches. It summarises common pragmatic methodologies and methods in health professions education research (HPER). The chapter explains the main indicators of quality employed in pragmatic approaches. It analyses the strengths and challenges of pragmatic approaches for HPER and focuses on the applicability of pragmatic approaches. The chapter presents four case studies to illustrate important issues and considerations when using a pragmatic approach and to explore when a pragmatic approach may be useful to consider in HPER. It provides a brief history of pragmatism explaining multiple theorists' contributions to the philosophy. The chapter considers whether and how each element – axiology, ontology, epistemology, and methodology – aligns with the personal philosophies. Three pragmatic methodologies that are compatible with pragmatic approaches include mixed methods, action research, and constructivist grounded theory.