Humanitarian actors seeking to offer assistance and protection to civilians in many contemporary conflicts negotiate access with armed groups from a position of weakness. They consequently concede many of their demands, compromising humanitarian operations and principles, and leaving millions of vulnerable civilians beyond reach. Using a structural analysis of the negotiation process in many recent humanitarian crises this article demonstrates the basis of this marked power asymmetry and challenges the assumption in much of the literature that this power imbalance is immutable. Humanitarian negotiators have access to a range of tactics that can alter the structure of the negotiation to reach more favorable outcomes. This article argues that these strategies have proved effective in many recent negotiations, but also carry significant risks to humanitarian actors and to the civilians they seek to assist.