This chapter explores disparities in access to surgical education and training across the United States, highlighting how geographic, gender, racial, and mentorship inequalities impact the development of the surgical workforce. Most US surgical programs are heavily concentrated in urban centers, leaving rural regions underserved and contributing to medical deserts. This geographic imbalance, combined with stagnating growth in surgical residency positions, has worsened surgeon shortages in vulnerable communities. Significant demographic disparities also persist among surgical trainees with recent evidence suggesting female and underrepresented-in-medicine (URiM) residents experience higher attrition rates and reduced operative exposure compared to their White, male peers. Black residents in particular report markedly lower operative volumes. Mentorship gaps compound these issues, with a third of trainees lacking effective guidance, negatively affecting autonomy, burnout, and retention. Regional differences in compensation and support further discourage practice in underserved areas. In response, initiatives such as rural surgery training pathways, expanded residency programs in Medically Underserved Areas (MUAs), and curricular reforms promoting health equity have been introduced. Technological innovations, including VR-based simulation and cognitive training apps, offer additional tools to improve access to quality surgical training. Expanding training opportunities in rural and underserved areas, enhancing mentorship, and addressing disparities in operative experience are critical steps toward improving healthcare access and outcomes nationwide.