For a given voice quality, VoIP does not offer a particularly efficient transport solution. This becomes a concern in any bandwidth-constrained part of a network, in particular, a copper-based, access network. VoIP access systems need to be carefully designed if they are to offer an acceptable combination of quality and efficiency. This paper identifies and quantifies the various issues which need to be addressed in undertaking such a design, and suggests possible solutions. The challenges of distributing VoIP within the customer premises are also addressed, with specific and different solutions being proposed for the business and residential environments.