This paper will discuss the various challenges and issues associated with the design of foundations for tall buildings. A three-stage approach to design will be described, involving a preliminary stage, a detailed stage, and a final stage. In each stage, the parameters and the design analysis involved should be consistent. The various risk factors in the design will be outlined, together with the measures that can be taken to reduce these risks. The critical importance of the geotechnical characterization of the site will be emphasized and the assessment of the key parameters will be discussed. Two examples of the application of the design process to tall buildings, one in Dubai and the other in South Korea, will be presented. Finally, another issue that may be of importance in congested urban environments, multiple building interaction, will be mentioned.