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The design and focus of IMF programs have profound consequences for the populations, economies, and politics of borrowing countries. These features of IMF programs are hashed out during intense periods of negotiation when IMF staffers visit prospective recipient countries. Over a period of weeks, sometimes months, IMF and borrowing country officials pore over economic statistics, debate the design of reforms, and reach compromises. However, this phase of IMF activity has received much less attention than other phases of IMF activity, such as Board approval or program implementation. In this paper, we introduce a novel dataset on the duration, intensity, location, and participants of IMF missions. In some cases, programs are agreed after a single two-week mission. In others, negotiations recur over five separate missions stretching over multiple years. What explains when programs are more difficult to negotiate? We investigate the relevance of factors in both creditor and recipient states, including shareholders’ geopolitical motivations, financial market exposure, recipient ideology and domestic support. Furthermore, we investigate how missions are related to the ultimate design of IMF programs. In so doing, we shed light on the bureaucratic workings that underpin these high-stakes international programs.