Large‐scale synthesis enables drug discovery, clinical development, and commercialization for new small molecule medicines. Several key disciplines collaborate to develop and define chemical processes, and ensure that they are suitable for large‐scale manufacturing activities. This article will discuss how new drugs transition from the medicinal chemistry laboratory, to kilo‐scale facilities, to pilot, and eventually to commercial scale. Important topics along the way include route selection, process safety, environmental considerations, equipment and facility types, scale‐dependent phenomenon, continuous processing, outsourcing, development models, and regulatory considerations. The article concludes with recent two case studies that highlight some of the topics covered and exemplify the power of process development and large‐scale production for modern small molecule drugs.