OBJECTIVE The American population continues to increase in ethnic diversity. However, the medical work force has lagged behind these population trends. We evaluated the extent of diversity and perceived barriers to multicultural training in American urology programs. METHODS A 25-question nonvalidated diversity questionnaire was distributed electronically to 112 American urology residency program directors. RESULTS A total of 62 program directors (55%) responded, representing all American Urological Association geographic regions nationwide. Of the respondents 92% were male and 90% were older than 40 years. During their residency 44% of respondents reported no female co-residents and 51% reported no co-residents of color. As faculty, 40% of respondents reported no female colleagues and 49% reported no colleagues of color. Of the respondents 75% identified no formal process to recruit faculty of color. With regard to current residency training 36% of respondents reported 1 or fewer female residents, 66% reported at least 1 black resident and 42% reported at least 1 Hispanic resident in their program. Of the respondents 75% stated that multicultural training is important for residents and 46% reported no barriers to multicultural training. However, 75% of program directors reported no formal multicultural program training. CONCLUSIONS Most urology program directors trained with few minority or female co-residents. This paucity of diversity has continued with current faculty members. Residents are increasingly diverse but few urology residency programs have a formal curriculum or mentors to address diversity issues. Therefore, current residency training may not encourage diversity at academic centers or adequately prepare residents to serve an increasingly diverse patient population.