This chapter explores the origins and evolution of the Games in the context of a region that had experienced important political, cultural, and economic changes. Due to an increased awareness within the public sector of the role of sport, the last decade has witnessed the passage of sport legislation and the establishment of public agencies in many South American countries. Both have contributed to justify public investment in sport. While the future of the South American Games lies in the hands of the governing body ODESUR, growth and sustainability depends on governments’ willingness to fund and support these initiatives. The rise of the South American Games provides evidence of the critical role sport plays as a part of the public policies of the countries in South America.