In the United States (US) and Canada, paratransit refers to transportation services that supplement scheduled, fixed route, mass transit to eligible passengers, namely people with disabilities and a growing number of older adults. This paper presents a critical systematic review of the literature on paratransit in the US and Canada since 2010 (n = 57), investigating what is known about paratransit, as well as the methodological and conceptual approaches privileged in this literature. Three separate approaches to the study of paratransit were identified. The first approach is paratransit modeling (n = 22). Under this approach, papers focus on demand modeling and route optimization (n = 12), cost optimization (n = 6), or quality of service and system information management (n = 4). Papers under the second approach, alternatives (n = 15), all propose different ways to provide paratransit services, including public–private partnerships (n = 6), autonomous vehicle technologies (n = 5), and the diversion of current paratransit user toward other modes (n = 4). Thirdly, many papers examine current services (n = 20), relating to system performance (n = 9), operational considerations (n = 7), or user perspectives (n = 4). When combined with a strong bias toward quantitative studies (77%) the perspectives of paratransit users are under-represented in the literature, over-shadowed by a focus on cost-cutting and improving operational efficiency. These trends are discussed in relation to neoliberalism and Critical Ableist Studies. Future research should directly involve paratransit users, engage in theory, and embrace qualitative methods.