This paper examines the phonology of pitch accents in Chickasaw, a Muskogean language of Oklahoma. Chickasaw is typologically unusual in displaying a predominantly top-down prominence system, in which phonological and morphological factors that are irrelevant for word-level stress play a crucial role in positioning the pitch accent in an Intonational Phrase. Word-level stress docks on the same syllable as the pitch accent, leading to asymmetries between stress patterns found in words carrying a pitch accent and words without a pitch accent. This type of top-down prominence system emerges naturally in Optimality Theory through an inviolable constraint requiring alignment of pitch accents and stress, coupled with the ranking of certain phrasal pitch-accent constraints above word-level stress constraints.