Precision medicine is an approach to healthcare that uses an individual’s unique genetic, environmental, and lifestyle factors to inform healthcare recommendations and decisions. While nearly universally agreed that this approach should improve patient-centered care, the details of its implementation remain elusive in many fields, including lung disease and especially pulmonary vascular disease. New Omics technologies such as genomics, transcriptomics, metabolomics, and proteomics offer promise to understand mechanisms of and risk factors for pulmonary vascular disease in the context of chronic lung disease, a heretofore little studied area. Moreover, these Omics technologies will facilitate understanding an individual’s unique molecular signature and may advance precision medicine in this field. This chapter will discuss what is known and not known in precision medicine approaches to pulmonary vascular disease in chronic lung disease and provide a roadmap for future studies to move the field forward through lessons learned in other similar disease states.