The authors discuss the decline in the numbers of black men enrolling in medical school over the last two decades and assess possible reasons for it, including the smaller numbers of men from nearly all races and ethnic groups now applying to medical school, the declining popularity of the undergraduate biology degree among men in general, the falling number of black students who go on to college, and, underlying all these, the pervasive effects of poverty on educational achievement, the dwindling employment opportunities for black men of limited education (brought on by dramatic changes in the American economy), and the rising indices of stress and alienation among black men. The authors review the larger social implications of the growing educational gap between black men and other segments of society, pose questions about some of the trends that have been mentioned, indicate lines for further research, and propose potential solutions to the problem of the deepening underrepresentation of black men in medical schools.