This chapter studies foreign policymaking by regional states in the Middle East based on a ‘complex realist’ approach. This acknowledges the weight of realist arguments but highlights other factors such as the level of dependency on the United States, processes of democratization, and the role of leadership in informing states' foreign policy choices. To illustrate this approach, the chapter examines decision-making by four leading states — Saudi Arabia, Iran, Turkey, and Egypt — in relation to the key events and crises of the last decade: the 2003 Iraq War; the 2006 Hezbollah War; and the post-2014 War with the so-called Islamic State of Iraq and Syria (IS). The cases indicate that, as realists expect, states' foreign policies chiefly respond to threats and opportunities, as determined by their relative power positions.