Hi Mark Palladino,
Welcome to the Microsoft Q&A Platform. Thank you for posting your query here.
The Azure account you use to configure Start VM on Connect must have the Desktop Virtualization Host Pool Contributor role-based access control (RBAC) role assigned.
To configure Start VM on Connect, you need to assign the Desktop Virtualization Power On Contributor role-based access control (RBAC) role to the Azure Virtual Desktop service principal with your Azure subscription as the assignable scope. If you assign this role at any level lower than a subscription, such as the resource group, host pool, or VM, prevents Start VM on Connect from working properly.
Also, please check and confirm if the VM show as Healthy in the Azure Portal/PowerShell?
Please go through the document for reference: https://learn.microsoft.com/en-us/azure/virtual-desktop/start-virtual-machine-connect?tabs=azure-portal#create-a-custom-role-for-start-vm-on-connect
Please feel free to tag me in the comments for any queries!
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