Every day, there are unrecognized sex trafficked victims visiting urban academic health systems in the United State, victims who are perhaps hoping against hope that a frontline provider, student, or staff member would ask that one question that would identify them as enslaved or otherwise trapped in an unthinkable situation. Health care providers’ lack of awareness of the relatively hidden population of sex trafficked victims causes missed opportunities to improve public health. Training healthcare providers to recognize and serve sex trafficked victims is critical, but such training will likely be less effective without addressing the institutional capacity of urban academic health systems. Indeed, local sex trafficking industries can thrive in the shadow of urban health systems, many associated with world class universities. This exploratory study aimed to assess and enhance the institutional capacity of an urban academic health system in the United States, and that of its employees, to appropriately serve victims of sex trafficking.