Undocumented immigrants experience health and treatment disparities exceeding those experienced by other immigrants (Hacker et al., 2011). Behavioral health providers in multidisciplinary medical settings play an integral role in the delivery of services to the 11 million undocumented immigrants residing in the United States, most of whom are Latina/o. Undocumented immigrants face cultural, legal, language, and psychological barriers that affect healthcare access, treatment utilization, and adherence (Achkar and Macklin, 2009). In the context of these disparities, little consensus exists regarding an ethical decisionmaking process specific to this population. How does a behavioral health provider respond to these dilemmas? This article reviews the changing sociopolitical landscape for the healthcare of undocumented immigrants. Case vignettes highlight and address important ethical issues arising from behavioral health providers’ work with this population. We conclude with recommendations regarding the navigation of these ethical challenges and the provision of high quality, accessible healthcare to undocumented immigrants.