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In this article, Dr. Naheed Dosani, the founder of the Palliative Education and Care for the Homeless (PEACH) program, shares his insight on topics ranging from integrating structural vulnerability into clinical practice to engendering changes within the community through translation of an idea into a real-world program. PEACH is a community-based organization that aims to provide high-quality and easily accessible palliative care to individuals that are homeless. We explore key tenants of palliative care such as harm reduction and trauma- informed care and their applicability for homeless or transiently housed patients. Dr. Dosani describes the unique elements of PEACH and the Journey Home Hospice (JHH), including accepting referrals from care workers, and the practical logistics of building this successful program in just a few short years.