For more than 30 years, commentators have been questioning the processes that medical schools and teaching hospitals use to search and recruit their leaders. Recent studies suggest that these problems persist, not only within academic medicine but across industries and countries.The authors' thesis in this article is that the search process, although always important, will be of even greater consequence than before, given the current environment for academic medicine. They (1) demonstrate why the academic medicine sector faces an impending talent crisis, (2) review the evidence on how a systematic approach to talent development has important organizational outcomes, (3) review the current state of the search and recruitment process for leaders in academic medicine centers, and (4) underscore the use of a continuous improvement approach as a way to improve the search process.The authors describe one such approach, which included retaining a core set of search committee members from one search to the next, appointing an associate dean for leadership development who instilled consistency in search and recruitment processes, and evaluating and making improvements to the search process via participant and stakeholder feedback.