A precise understanding of how hematopoietic stem cells are patterned during development has important implications for both developmental biology and regenerative medicine. Since hematopoietic stem cells are the only hematopoietic cells capable of lifelong, multilineage blood cell production, understanding the stepwise, molecular processes of their instruction from mesoderm is key to replicating these events in vitro from pluripotent embryonic stem cells. The current understanding of hematopoietic stem cell specification is presented, with an outlook on future regenerative medicine approaches.