This paper presents a fundamentally new approach to global register allocation that optimally allocates registers and optimally places spill code, significantly decreasing spill code overhead compared with the traditional graph-coloring approach. The Optimal Register Allocation (ORA) approach formulates global register allocation as a 0-1 integer programming problem, incorporating all aspects of register allocation within a unified framework, including copy elimination, live range splitting, rematerialization, callee and caller register spilling, special instruction-operand requirements, and paired registers. A prototype ORA allocator is built into the Gnu C Compiler (GCC). For the SPEC92 integer benchmarks, the ORA allocator actually produces a net decrease of more than 100 million cycles across the entire benchmark set, because the dynamic copies the ORA allocator removes exceed the dynamic loads and stores that are inserted. In contrast, the GCC allocator and a Chaitin-style graph-coloring allocator each cause a net increase of more than 1 billion cycles. Because global register allocation is NP-complete, optimal register allocation has been considered intractable. However, the run-time complexity of the ORA approach is shown experimentally to be O(n3). A profile-guided hybrid allocation approach is proposed that uses the ORA allocator for the performance critical regions in the performance critical functions, while using a graph-coloring allocator for the non-critical functions and regions. An ORA-GCC hybrid allocator takes an average of 4.6 seconds per function to produce an allocation that is within 1% of optimal for 97% of the SPEC92 integer benchmark functions, showing that the hybrid allocator is practical as an advanced optimization for performance-critical codes.