This paper presents an evaluation framework designed for small and medium sized city automatic vehicle location (AVL)-based paratransit systems and describes the application of that framework to one such paratransit system in North Carolina. Issues addressed include the benefits of implementing AVL, whether AVL for paratransit can be used effectively in small to medium-sized cities, and the problems associated with implementing such technologies. The paper is meant to provide guidance for other similar AVL evaluation efforts. A controlled before and after study approach is used to evaluate the AVL system in the City of Winston-Salem, North Carolina (population 265,878). Key findings are that the paratransit systems efficiency improved slightly with AVL but that demand variables did not change significantly relative to non-AVL equipped vehicles. Reasons for this outcome are examined.