This chapter explores the ways in which the United States and several US-led multilateral institutions have adapted, or struggled to adapt, to China’s Belt and Road Initiative (BRI). The United States has weighed heavily on the transitions that two major multilateral institutions—the World Bank and the International Monetary Fund (IMF)—have made to adapt to the BRI and the rise of bilateral sources of infrastructure financing more generally. The World Bank, once a major financier of developing economy infrastructure, has struggled to reform its safeguards programmes in the wake of the BRI. The IMF has similarly struggled to adapt the programmes that it uses to assist countries in debt crises post-BRI. The United States has also created, or attempted to create, new bilateral or multilateral initiatives in the infrastructure sector to ‘compete’ with the Belt and Road, including the US Development Finance Corporation, the Blue Dot Network, the Partnership for Global Infrastructure, and the India–Middle East–Europe Economic Corridor. This chapter reviews those initiatives and the common challenges that they face in providing developing economy borrowers with an alternative source of infrastructure financing to the BRI.