The shortage of physicians and surgeons is well known and is anticipated to worsen over the next few decades. Starting a new General Surgery Residency is an important mechanism to increase the surgical workforce for the future. New program builds are very labor-intensive, requiring meticulous planning, thoughtful execution, and engagement of continuous quality improvement. In this chapter, we discuss some foundational principles of starting a General Surgery Residency from scratch and introduce tips and tricks to assist in the development of an enduring program that will have a long-term impact on training tomorrow’s surgeons.