Major environmental changes and recurring pressures have made universities in the United States that educate health care professionals vulnerable to corruption. Based on the experiences of one large, state-supported university, this essay argues that, in adapting to pressures, universities rely on the ordinary structures and processes characteristic of large formal organizations. Hierarchy becomes an opening to corruption when it is associated with low levels of transparency, a culture of deference that discourages questioning, and the absence of countervailing centers of authority. Where the need for resources is great and access is uncertain, these can become incentives to ensure access through corrupt means. Embeddedness opens opportunities for misconduct by fostering relations based on narrow loyalties. The ordinariness of the pathways to corruption in higher education can obscure timely recognition of misconduct even by members working in affected organizations. But, once recognized, it is also possible to find equally ordinary solutions.