This paper examines the historical record of ;;urban triage,” a controversialplanning policy that called for the rehabilitation of areas in the early stages of decline over those in greater need, with the goal of stabilizing the greatest part of the city with theleast resources. Similar policies are being proposed today in response to enduring population loss and fiscal crisis in cities like Youngstown, Flint, and Detroit, but fewcontemporary planners are aware of the previous cases or the body of planning literature that arose in response to them. Using planning records, newspaper accounts, andinterviews with planners involved in the cases, this paper first defines urban triage, situating the policy as a response to a deepening fiscal and urban crisis, cutbacks infederal aid, and the transition from categorical federal grants to block grants. It then analyzes the challenges planners faced, practically and politically, in their efforts to turnurban triage into policy in St. Louis and Cleveland. It argues that urban triage was distinct from policies of urban renewal or planned shrinkage and could be justifiedtheoretically in terms of both efficiency and equity. However, in practice, the difficulty of implementing urban triage appears to have prevented the realization of either goal.