Trauma care in the USA is fragmented, unequal, and millions of people lack adequate access to a trauma center. These inequities are the result of historic precedent, racial and socioeconomic discrimination, and the economics of trauma care. The fixed location of trauma centers may also fail to meet the needs of moving and changing populations. Further, the current methods of trauma center formation perpetuate existing inequity by leaving the pursuit of trauma center creation up to hospitals, resulting in verification and designation processes that are mostly reliant on financial capability rather than community need. This particularly impacts those who are socioeconomically vulnerable, as existing trauma centers may not be accessible to their communities and new centers may not seek to serve them. On the contrary, already well-resourced communities increasingly receive duplicative care. A thorough understanding of the interplay between trauma center designation, socioeconomic and geographic disparities in trauma care-and potential levers for change-is crucial in trauma systems planning for more equitable trauma care.