At Southern Vermont College (SVC) and at the nation's other colleges and universities, Anatomy and Physiology I (A&PI) is the gateway course into healthcare careers. Disturbingly, at SVC and elsewhere, many first-year students interested in healthcare careers do not succeed in this course. They withdraw from the course or the institution, or their final grade may be below the identified threshold for progressing in their programs. In short, A&PI has become a gatekeeper course that prevents students from entering careers where they are sorely needed. While academic failure is a complicated issue, the literature suggests that the students most likely to succeed in A&PI have strong mathematics and science backgrounds and come from high schools with rigorous programs of study. Many of the students at schools like SVC are first-generation students and/or Pell-eligible students, and they have relatively low SAT/ACT scores. These students do not enter colleges from programs of study that have prepared them for A&PI, particularly in their first semester of college. Faced with the challenges at SVC, the authors decided to launch a Pilot A&PI course designed for vulnerable first-year students. They identified first-year students they deemed academically at risk, and they were offered an opportunity to enroll in a re-envisioned A&PI course. In this article, the authors discuss the key features of the pilot as well as the results of the pilot. (Contains 2 charts.)