By providing HIV pre-exposure prophylaxis, or PrEP (a single daily oral pill), in a primary care college health setting, clinical providers can make a dramatic contribution to the current and long-term health and well-being of the students they see. This viewpoint article describes the approach taken to instituting primary care PrEP services at two college health programs. It delineates which students might benefit from PrEP and how to prescribe/monitor PrEP over time. Additionally, common barriers to PrEP are reviewed, including concerns about affordability, and the concerns that the use of PrEP will encourage risky sexual activity. Implementation strategies are discussed, including identifying a clinic champion, partnering with knowledgeable colleagues, and developing an educational campaign.