Unfortunately, we are ill prepared to meet the coming needs for geriatric mental health care. In fact, the seismic demographic shift in the number of mentally ill older adults is paradoxically coupled with a decreasing number of mental health care providers, especially geriatric psychiatrists. Today there are about 1,700 board-certified geriatric psychiatrists in the United States—one for every 23,000 older Americans. That ratio is estimated to diminish to one geriatric psychiatrist for every 27,000 individuals 65 and older by 2030. Yet, little is being done to address this challenge. Already geriatric psychiatric services are in high demand, and specialists are in short supply. The trainee pool is a critical issue. Currently, there are 120 geriatric psychiatry fellowship training slots nationwide, but only half of them are filled. Psychiatry residents are drawn away from geriatric psychiatry fellowships, at least partly because of financial concerns over large student loans. Medicare reimbursements are decreasing, and the reimbursement system as a whole makes psychiatric care difficult to access for older patients. The dual stigma against aging and mental illness also makes geriatric psychiatry less attractive to many trainees.