The American Board of Urology (ABU) offers an alternate pathway into the ABU certification process for urologists who are international medical graduates (IMG). This pathway is intended for candidates who contribute to the field of urology through scholarship, education, and research. IMGs in very specific educational roles and with exceptional clinical skills may apply to the ABU for a variance to enter the certification and subspecialty certification processes. The ABU views this situation to be extraordinary and will approve or disallow the variance on a case-by-case basis. The requirements for application and entrance into the certification process can be found on our website (http://ow.ly/VmgZ50MwgaK).