The end of life can be a highly emotional and difficult time for patients and their families. Advance care planning for end-of-life care is one option for helping to mitigate the burden of this experience. Despite its advantages, gaps in end-of-life advance care planning participation persist, particularly among underserved segments of the U.S. population who might benefit from it. This column highlights barriers to end-of-life advance care planning among medically underserved populations and discusses opportunities for greater engagement.