Structural explanations of career choice and development are well established. Socioeconomic inequality represents a powerful factor shaping career trajectories and economic outcomes achieved by individuals. However, a robust and growing body of evidence demonstrates a strong link between socioeconomic inequality and health outcomes. Work is a key factor explaining differences in income and lifestyle. It seems unavoidable that inequality in careers has profound consequences for health and well-being, but this relationship is largely ignored by career scholars. Some implications of health inequality for career guidance interventions are suggested.