This article is intended as a practical guide to the various methods of patient assignment in clinical trials. Topics discussed include a critical appraisal of non-randomized studies, methods of restricted randomization such as random permuted blocks and the biased coin technique, the extent to which stratification is necessary and the methods available, the possible benefits of randomization with a greater proportion of patients on a new treatment, factorial designs, crossover designs, randomized consent designs and adaptive assignment procedures. With all this diversity of approach it needs to be remembered that the effective implementation and reliability of a relatively straightforward randomization scheme may be more important than attempting theoretical optimality with more complex designs.