Outsourcing of business processes and information technology (IT) operations is an important trend in large and middle-sized organizations. However, outsourcing could affect the organization’s ability to align its IT with business strategy and operations. This article reports a qualitative study into the relationship between IT outsourcing (ITO) and business and IT alignment. It aims to provide recommendations for outsourcers and service providers on how outsourcing relationships should develop in order to support business and IT alignment. The research question of the study is “What is the effect of IT outsourcing on the business and IT alignment of companies that have outsourced their IT?” After a review of relevant literature and concepts, four cases are reported. The study revealed that a higher level of motivation for outsourcing paired with a higher level of the relationship between outsourcer and service provider and with a higher level of alignment maturity of the outsourcer. The study also showed that the ITO relationship is influenced by organizational turbulence on one or either side of the relationship and that the service providers tend to assess the relationship on a higher level than the outsourcers. These conclusions provide relevant directions for both outsourcers and service providers for improvement of the their relationship.