Acoustic design considerations for hearing impaired populations are widely misunderstood outside of the acoustics community. Some clients have even expressed the sentiment that room acoustics are not important because their patrons are hard of hearing. Contrary to this widely held belief, acoustical design is more critical for these populations. To properly design spaces for these communities, it is imperative to take a holistic approach, which considers not just architectural acoustics, but incorporates an understanding of the biological and psychological components of hearing impairment. It is also important to consider how room systems can be integrated with modern hearing technology. Addressing room acoustics, background sound levels, and audio technology should all be considered in the strategy of designing for hearing impaired persons. This is important not only for their comfort, but also for their health. Strategies and implications for a holistic approach will be discussed.