In August 2009, the Herbert Wertheim College of Medicine Medical Library opened its doors to students, faculty, and staff. One of the many challenges before opening the library was developing a unique and autonomous interlibrary loan service for its patrons. This article examines the decisions in choosing the best document delivery system, the management of funds, and the selection of holdings for a new medical library. Along with these decisions, there is discussion on the significance of costs, turnaround times, and challenges going forward. Reprinted by permission of the publisher.