The community health center is a new institution which has been promoted by the Office of Economic Opportunity to provide health services to the poor, to establish an alternate model for medical practice, and to help reintegrate the poor into the mainstream of society. Among the barriers to the success of this innovation has been a lack of political realism on the part of many of the participants. A sociological analysis of the process of project evolution, demonstrating the many opportunities for controversy and conflict to develop, is presented. Inferences from conflict theory are presented to show how a sophisticated approach to controversy can expedite social change. If health professionals are to be involved in the wide range of social and physical ills of their patients they must be familiar with these strategies.