How should rational believers pursue the aim of truth? Epistemic utility theorists have argued that by combining the tools of decision theory with an epistemic form of value—gradational accuracy, proximity to the truth—we can justify various epistemological norms. I argue that deriving these results requires using decision rules that are different in important respects from those used in standard (practical) decision theory. If we use the more familiar decision rules, we can’t justify the epistemic coherence norms that epistemic utility theory had hoped to justify. In short, those of us who are attracted to the project of epistemic utility theory face a dilemma. If we choose “consequentialist” rules, then we can vindicate the idea that rational belief has the aim of accuracy—but at the cost of giving up attractive epistemic norms.