Textbook prices have dramatically increased by 812% from 1978 to 2013, with students spending an average of $2000 annually as of 2014. A study of 3,000 books showed that 71.5% are required texts, with costs ranging from $0.99 to over $400, and 40% of books with prices available in electronic formats. Challenges in increasing awareness and accessibility of open textbooks are highlighted.