There are few conditions in emergency medicine as potentially challenging and high-risk as the difficult or failed airway. The emergency physician must be able to anticipate the difficult or failed airway, recognize associated physiologic deficits, and plan accordingly. Preparation, pretreatment strategies, and selection of alternative airway devices may mitigate the potential morbidity and management failure associated with the high-risk airway. There are a myriad of airway devices new to emergency medicine, which can increase the chance of successful airway management and rescue. Understanding why the airway is potentially difficult and assessing whether oxygenation can be maintained can guide the clinician’s strategy and technique for successful management of the high-risk airway.