Lithographic precision is as or more important than resolution. For decades, the semiconductor industry has been able to work with +/- 5% precision. However, for other applications such as micronanoelectromechanical systems, optical elements, and biointerface applications, higher precision is desirable. Lyding [Appl. Phys. Lett. 64, 11 (1999)] have demonstrated that a scanning tunneling microscope can be used to remove hydrogen (H) atoms from a silicon (100) 2 x 1 H-passivated surface through an electron stimulated desorption process. This can be considered e-beam lithography with a thin, self-developing resist. Patterned hydrogen layers do not make a robust etch mask, but the depassivated areas are highly reactive since they are unsatisfied covalent bonds and have been used for selective deposition of metals, oxides, semiconductors, and dopants. The depassivation lithography has shown the ability to remove single H atoms, suggesting the possibility of precise atomic patterning. This patterning process is being developed as part of a project to develop atomically precise patterned atomic layer epitaxy of silicon. However, significant challenges in sample preparation, tip technology, subnanometer pattern placement, and patterning throughput must be overcome before an automated atomic precision lithographic technology evolves.