Spurred by its rapidly changing demographics, the United States is striving to reduce and eliminate racial and ethnic health disparities. To do so, it must overcome the legacy of individual, institutional, and structural racism and resolve conflicts in related political and social ideologies. This has moved the struggle over diversity in the health professions outside the laboratories and ivy-covered walls of academic medicine into the halls of Congress and chambers of the US Supreme Court. Although equal employment opportunity and affirmative action programs began as legal remedies for distinct histories of legally sanctioned racial and gender discrimination, they also became effective means for increasing the representation of underrepresented minorities in higher education and the health professions. Beginning in the 1970s and continuing today, legal challenges to measures for realizing equal opportunity and leveling the playing field have reached the US Supreme Court and statewide ballot initiatives. These historical challenges and successes are the subject of this article. Although the history is not exhaustive, it aims to provide an important context for the struggles of advocates to improve the representation of underrepresented minorities in medicine and reduce racial and ethnic health disparities.