We show how to triangulate a three dimensional polyhedral region with holes. Our triangulation is optimal in the following two senses. First, our triangulation achieves the best possible aspect ratio up to a constant. Second, for any other triangulation of the same region into m triangles with bounded aspect ratio, our triangu- lation has size n=O(m). Such a triangulation is desired as an initial mesh for a finite element mesh refinement algorithm. Previous three dimensional triangulation schemes either worked only on a restricted class of input, or did not guarantee well shaped tetra- hedra, or were not able to bound the output size. We build on some of the ideas presented in previous work by Bern, Eppstein, and Gilbert, who have shown how to triangulate a two dimensional polyhedral region with holes, with similar quality and optimality bounds.