A common practice in medical education is to create a prescribed distribution of grades, or ratings, so that only a certain percentage of students receive the highest marks. This approach typically is employed to curb grade inflation and as a means to help faculty distinguish outstanding performers. Despite the well-intentioned reasoning for using prescribed grade distributions, a number of associated problems and probable consequences may result from this practice. Thus, the purpose of this article is to discuss the assumptions underlying this potentially unwise practice, the defensibility of this evaluation practice in the high-stakes arena of medical education, and the unintended consequences that such practices and policies may have on a student body and the larger educational environment.