The introduction of physician assistants (PAs) into Alaska began in 1971 with seven MEDEX Northwest students, who were paired with physician preceptors for 12 months. Scores of PAs were recruited as health officers on the Trans-Alaska Pipeline System starting in 1974, and by 1977 the state had 200 PAs. In 1979, the Alaska Board of Medical Examiners ratified the first set of regulations and began issuing licenses the following year. Throughout the 1970s and following pipeline completion, more PAs were employed by private, state, and federal agencies to meet the needs of a growing population. Forty years later, Alaska has one of the richest legacies in PA deployment of any state. This article is based on the authors’ memories, communications with those involved in the program, and historical documents archived at the MEDEX Northwest Physician Assistant Program at the University of Washington in Seattle, along with Alaskan archival sources.