Medical coverage of ultramarathons must take into account unique logistical, environmental, and psychological components in addition to the medical conditions that may arise. Each ultramarathon is unique and carries with it distinct specific challenges with regard to appropriate planning and organizing. The medical issues encountered with ultramarathons can overlap with those seen in other endurance events, but the extreme and protracted nature of ultramarathons also lends itself to various other medical challenges not frequently encountered in other aspects of sports medicine. This article gives an overview of logistical considerations that go into the medical planning, as well as information regarding diagnosis and acute management of some of the most common and most important conditions that one might encounter when covering an ultramarathon.