This article describes how the reference department at a large academic health sciences library evolved to address the clinical and research information needs of the parent organization without losing its close connections to the classroom and curriculum. Closing the reference desk, moving to on-call and house call models, designing positions such as clinical research librarian and basic biomedical sciences librarian, finding alternative funding to grow the department, providing technology and training to facilitate librarians' work, and developing programming for and taking advice from library clients facilitated efforts to create a relevant presence and solidify the library's place in the university community.