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Implantable medical devices impose a tremendous set of constraints on their system-level components. The limitations of these components inevitably result in design compromises that become necessary in order to achieve minimum therapeutic requirements. Recent advances, from companies like Texas Instruments, in the semiconductor industry in power consumption, reliability, real-time processing, chip-level integration, and packaging have made possible a new wave of implants. Gene Frantz has influenced several of these advances. This article looks at the challenges faced by the systems engineer embarking on the designs of tomorrow's implants, using today's technologies while preparing for the advances yet to come.