AI agents are actively running in production across diverse industries, yet little is publicly known about which technical approaches enable successful real-world deployments. We present the first large-scale systematic study of AI agents in production, surveying 306 practitioners and conducting 20 in-depth case studies via interviews across 26 domains. We investigate why organizations build agents, how they build them, how they evaluate them, and what the top development challenges are. We find that production agents are typically built using simple, controllable approaches: 68% execute at most 10 steps before requiring human intervention, 70% rely on prompting off-the-shelf models instead of weight tuning, and 74% depend primarily on human evaluation. Reliability remains the top development challenge, driven by difficulties in ensuring and evaluating agent correctness. Despite these challenges, simple yet effective methods already enable agents to deliver impact across diverse industries. Our study documents the current state of practice and bridges the gap between research and deployment by providing researchers visibility into production challenges while offering practitioners proven patterns from successful deployments.