For great performance with SQL Server on an Azure VM, you need to first size the VM for your workload, paying attention to CPU, memory, and storage I/O capabilities. You can easily select the right configuration for your workload with the vast array of Azure VMs available. Many have been configured to provide the best price for performance for SQL Server workloads. By leveraging the highest generation VM sizes with Azure BlobCache and ultra disks, you can run just about any size SQL Server workload on an Azure VM. To know what size VM you need, you'll need a baseline, and to have SQL Server run as smoothly as possible, you'll want to ensure that you've configured it properly for your workload. In addition to SQL Server configuration settings, there are key changes to make in Linux environments, especially setting noatime to reduce wasteful I/O.