Middle East Respiratory Syndrome (MERS) caused by a single-stranded, positive-sense RNA beta-coronavirus (MERS-CoV) was first isolated in Jeddah, Saudi Arabia. Approximately 180 cases of MERS have occurred in a recent Korean outbreak. Clinical features vary from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome and/or multiorgan failure. To control acute respiratory failure, endotracheal intubation is frequently required; in most patients with prolonged endotracheal intubation, tracheotomy is mandatory to appropriately control the airways and to avoid serious complications of extended intubation. Tracheotomy can be a high-risk procedure because it generates profuse droplets and aerosols, which in turn promote interpersonal dissemination of the virus. Herein, we report the first tracheotomy case in a Korean MERS patient to describe appropriate airway management and protection of medical staff.