Patients enrolled in clinical trials should reflect the populations affected by the disease. However, this is often not the case for racial and ethnic underserved populations, especially those who are elderly, have comorbidities, or live in rural locations. This article addresses and refutes misconceptions that contribute to the underrepresentation of certain populations in clinical trials, including a belief that individuals from racial and ethnic minority groups inherently distrust health care and clinical research; assumptions and unconscious bias by principal investigators that patients from underrepresented groups are unlikely to participate in clinical trials and therefore are not invited to enroll; and the misconception that establishing a practice in an underserved area or proactively engaging with underserved communities is not a financially viable strategy. The article also offers strategies to promote patient inclusion and advance health equity.