During the last several decades, new milking management systems have been introduced, of which development of automatic milking (AM) systems is a significant step forward. In Europe, AM has become an established management system and has shown to be much more than milking management. Factors such as milking, milk quality, feeding, cow traffic, grazing, and animal behavior are essential elements of AM. This system offers possibilities for more frequent milking and can be adapted to lactational stage. Increased milk yield with AM has been observed, but lack of increased production has also been reported from the field, probably due to less attention paid to the total management system. The AM system provides consistent milking routines, with those for teat stimulation and feeding during milking giving an adequate oxytocin release and milk ejection. Initially, reduced milk quality, such as increased FFA, total bacteria count, and somatic cell count (SCC), was observed. Increased FFA could be due to increased milking frequency or handling of the milk, although this has not yet been determined. The elevated total bacteria count was probably due to mismanagement because later studies indicated that teat cleaning in AM is sufficient to reduce spores and dirt on the teats. Significant positive effects on udder health and teat treatment were observed in some studies, possibly as an effect of quarter milking, a procedure whereby an individual teat cup is detached when milk flow is below the preset level for detachment. Well-functioning cow traffic is a prerequisite for successful AM system performance to obtain an optimal number of visits to the feeding area and the milking parlor for all cows. Technical stoppages in the AM system (i.e., the milking unit) increased milk SCC, and the variation and length of the milking interval seem to contribute to elevated SCC. Grazing is a common management routine in many countries. Different ways to motivate the cows to visit the milking parlor, such as shorter distance between barn and pasture, supplement feeding, access to water, and use of acoustic signals, have been tested. It was concluded that use of AM and grazing systems together is possible as long as the distance from the milking parlor to pasture is short. With proper management routines, it is possible to achieve a production level and animal well-being in AM systems that are at least as good as in conventional milking systems.