The path to medicine for underrepresented, low income, and first-time students has steeper hills than that of their peers. Roughly 50% of medical students come from the top quintile of household income, and ~75% come from the top two quintiles of household income. This distribution has not changed in three decades. Nevertheless, data suggests that students with these backgrounds apply in relatively high numbers. Structural barriers, such as the lack of ready access to premedical advising and uncertainty about planning for the costs of applying to medical school, prevent underrepresented, low income, and first-time students from successfully matriculating into medical school.