This chapter discusses the specific challenges faced by Icelandic students trained in traditional English as a Foreign Language (EFL) when they enter university programs that are partially or entirely taught in English (English as a Medium of Instruction, EMI). This includes the measures taken by the Department of English to meet English majors’ and non-English majors’ growing demand for academic English support. The lack of academic English skills of Icelandic students is a “hidden challenge” (Ingvarsdóttir and Arnbjörnsdóttir, 2014) caused by an overconfident perception of students’ English proficiency by University officials and by the students themselves. The goal of the Department of English is to bring students quickly to a level of academic English that allows them to access curriculum and instruction where ENL (English as a Native Language) norms are expected. As the identified challenges differ from those encountered in students’ previous EFL dominated environment with minimal writing experience, there is a critical need to adapt teaching and learning practices to a new linguistic context where English functions as an additional language. The article concludes with a description of a new intensive instructional approach that targets identified English academic literacy needs of students entering the University of Iceland. The foundation of the new approach is that all students can acquire skills in organizing ideas and composing clear and effective text in English across all genres. The approach accomplishes this by developing awareness of English writing conventions, knowledge about which strategies to employ and when to employ them, revision skills and the persistence to rewrite until the text authentically reflects the views of the author. The idea is that through writing, students also gain an awareness of the nature of English academic texts and thereby hone their reading skills.