diff --git a/docs/python-api.rst b/docs/python-api.rst
index cc34505..039a00a 100644
--- a/docs/python-api.rst
+++ b/docs/python-api.rst
@@ -522,7 +522,9 @@ This will create a table with the following schema:
 Explicitly creating a table
 ---------------------------
 
-You can directly create a new table without inserting any data into it using the ``.create()`` method::
+You can directly create a new table without inserting any data into it using the ``.create()`` method:
+
+.. code-block:: python
 
     db["cats"].create({
         "id": int,
@@ -534,6 +536,17 @@ The first argument here is a dictionary specifying the columns you would like to
 
 This method takes optional arguments ``pk=``, ``column_order=``, ``foreign_keys=``, ``not_null=set()`` and ``defaults=dict()`` - explained below.
 
+A ``sqlite_utils.utils.sqlite3.OperationalError`` will be raised if a table of that name already exists.
+
+To do nothing if the table already exists, add ``if_not_exists=True``:
+
+.. code-block:: python
+
+    db["cats"].create({
+        "id": int,
+        "name": str,
+    }, pk="id", if_not_exists=True)
+
 .. _python_api_compound_primary_keys:
 
 Compound primary keys
diff --git a/sqlite_utils/db.py b/sqlite_utils/db.py
index 4ab8862..1927f41 100644
--- a/sqlite_utils/db.py
+++ b/sqlite_utils/db.py
@@ -658,6 +658,7 @@ class Database:
         defaults: Optional[Dict[str, Any]] = None,
         hash_id: Optional[str] = None,
         extracts: Optional[Union[Dict[str, str], List[str]]] = None,
+        if_not_exists: bool = False,
     ) -> str:
         "Returns the SQL ``CREATE TABLE`` statement for creating the specified table."
         foreign_keys = self.resolve_foreign_keys(name, foreign_keys or [])
@@ -748,11 +749,14 @@ class Database:
                 pks=", ".join(["[{}]".format(p) for p in pk])
             )
         columns_sql = ",\n".join(column_defs)
-        sql = """CREATE TABLE [{table}] (
+        sql = """CREATE TABLE {if_not_exists}[{table}] (
 {columns_sql}{extra_pk}
 );
         """.format(
-            table=name, columns_sql=columns_sql, extra_pk=extra_pk
+            if_not_exists="IF NOT EXISTS " if if_not_exists else "",
+            table=name,
+            columns_sql=columns_sql,
+            extra_pk=extra_pk,
         )
         return sql
 
@@ -767,6 +771,7 @@ class Database:
         defaults: Optional[Dict[str, Any]] = None,
         hash_id: Optional[str] = None,
         extracts: Optional[Union[Dict[str, str], List[str]]] = None,
+        if_not_exists: bool = False,
     ) -> "Table":
         """
         Create a table with the specified name and the specified ``{column_name: type}`` columns.
@@ -783,6 +788,7 @@ class Database:
             defaults=defaults,
             hash_id=hash_id,
             extracts=extracts,
+            if_not_exists=if_not_exists,
         )
         self.execute(sql)
         table = self.table(
@@ -1300,6 +1306,7 @@ class Table(Queryable):
         defaults: Optional[Dict[str, Any]] = None,
         hash_id: Optional[str] = None,
         extracts: Optional[Union[Dict[str, str], List[str]]] = None,
+        if_not_exists: bool = False,
     ) -> "Table":
         """
         Create a table with the specified columns.
@@ -1318,6 +1325,7 @@ class Table(Queryable):
                 defaults=defaults,
                 hash_id=hash_id,
                 extracts=extracts,
+                if_not_exists=if_not_exists,
             )
         return self
 
diff --git a/tests/test_create.py b/tests/test_create.py
index d946d99..35844a1 100644
--- a/tests/test_create.py
+++ b/tests/test_create.py
@@ -1114,3 +1114,12 @@ def test_create(fresh_db):
         "   [bytes] BLOB\n"
         ")"
     )
+
+
+def test_create_if_not_exists(fresh_db):
+    fresh_db["t"].create({"id": int})
+    # This should error
+    with pytest.raises(sqlite3.OperationalError):
+        fresh_db["t"].create({"id": int})
+    # This should not
+    fresh_db["t"].create({"id": int}, if_not_exists=True)