Mr. Henry (a pseudonym) has visited our emergency department (ED) an average of 3 times a week for the past 5 years. He has a medical history of AIDS and end-stage renal disease, is addicted to cocaine and prescription opioids, and is intermittently homeless. His dialysis access is a frequent issue because, without stable housing, he is prone to frequent skin and soft tissue infections, complicating both fistulas and indwelling catheters. Despite receiving regular dialysis, he often visits the ED for urgent dialysis at least in part because he has access only to fast food in his neighborhood, which wreaks havoc on his fluid status and electrolyte levels. On a slow Thanksgiving Day shift this past year, he reflected on the role the ED plays in his life beyond addressing his medical needs: refuge from the cold, a social support system, a food kitchen, and even a place to get a jacket without holes.Mr. Henry’s experience is not unique; it represents a reality in EDs all across the country. In 1999, Gordon1 wrote that vulnerable and disadvantaged patients “define us as a specialty—as much, or more so, than the medical procedures we perform” and that “given the importance of social factors to health, emergency physicians who work daily at the interface of medicine and society have a special obligation to broaden their scope of practice.”In the modern ED, homelessness, substance abuse, and violence are as pervasive as coronary artery disease, diabetes, and hypertension, each with a clinical significance. In this environment, where does the responsibility of an ED begin and end? This question is as relevant to our daily practice as any clinical decision that we make.Social emergency medicine is an approach to our specialty that emphasizes, enriches, and creates a framework for emergency medicine as society's medical and social safety net. This view of emergency medicine considers the interplay between social forces and the emergency care system as they together influence the health of individuals and their communities, with the goal of improving population health while decreasing system costs. Various investigators in emergency medicine already take this approach, but this framework ought to become more integrated into our clinical practice, research agenda, and training programs. Here we explore how social emergency medicine can exist within, and buttress, an already strained emergency care system.