This article argues that black workers’ perceptions of racial discrimination derive not just from being in the minority, but also from their position in the organizational structure. Researchers have shown that black individuals encounter an enormous amount of racial discrimination in the workplace, including but not limited to exclusion from critical social networks, wage disparities, and hiring disadvantages. But fewer studies examine the extent to which black workers believe racial discrimination is a salient factor in their occupational mobility or the factors that might explain their divergent perceptions of racial discrimination. Based on 60 in-depth interviews with black medical doctors, nurses, and technicians in the healthcare industry, we show that black workers’ status within an organizational hierarchy fundamentally informs perceptions of the nature and type of workplace racial discrimination. These findings have implications for understanding how racial dynamics at work are linked to mental health, occupational satisfaction, and organizational change.