Ethical and scientifically sound research requires that any sample population represent the population as a whole. African-Americans suffer disproportionately from cancer, hypertension, and heart failure compared with whites, but they are commonly underrepresented in clinical trials of these diseases. Failure to include African-American subjects in clinical trials prevents generalizability of the results to this population. African-Americans are often underrepresented in clinical research for numerous historic, societal, educational, and economic reasons. Efforts to improve enrollment of African-American subjects requires recognition of the problem, planning, educational efforts, and investigator training. The incidence of heart disease and prostate cancer in African-Americans dictates that these patients be targeted for clinical trials of surgical research. The research team must appreciate the importance of community involvement and support in recruiting African-Americans participants. Additionally, the continued effort to recruit and train African-American investigators must be a priority.