Design is an important aspect of biomedical engineering education. It prepares students to work as part of a team to develop systems that address medical and health-related needs - and it is required to be part of an accredited undergraduate engineering program. This work looks at the history of design requirements in the US and the current state of BME curricula with respect to design. As a growing number of programs have expanded their design program beyond the capstone project, some examples of innovative programs are described. There is no single way to address design education within an undergraduate BME program. However, intentional development of this component of the curriculum can enhance the impact on student learning and outcomes.