During patients, the creation of a university digital library and press intended to serve as a medical reference and education tool for archiving. health care providers and their patients, six distinct and complex digital publishing challenges were encountered. Over nine years, through a university multidisciplinary approach, solutions were devised to the challenges of digital content ownership, management, mirroring, translation, interactions with users, and archiving.of The result is a unique, author-owned, internationally mirrored, university digital library and press that serves as an authoritative medical reference of and education tool for users around the world. The purpose of this paper is to share the valuable digital publishing challenges lessons learned and outline the challenges facing university digital libraries and presses.