Genetic improvement in dairy cattle is linked to the accumulation of inbreeding: concentrating reproduction on individuals with the highest estimated breeding values increases relatedness across the population. Genomic selection accelerated genetic gain while raising annual inbreeding rates in several breeds to levels five or more times higher than under progeny testing. The consequences include inbreeding depression across production, fertility, health, and longevity traits; elevated probability of expression of deleterious recessive alleles; and reduced effective population sizes that constrain long-term response to selection. This chapter reviews strategies for reconciling selection intensity with diversity maintenance. Coverage spans the genomic tools used to characterize inbreeding at individual and population levels; the biological consequences of its accumulation; optimal contribution selection, as applied in several programs, and the expected and genomic future inbreeding indices incorporated into North American genetic evaluations; complementary approaches including structured mating programs, germplasm exchange, and region-specific management of deleterious variants; and interactions with reproductive technologies.