We consider the problem of using observational data to learn treatment assignment policies that satisfy certain constraints specified by a practitioner, such as budget, fairness, or functional form constraints. This problem has previously been studied in economics, statistics, and computer science, and several regret-consistent methods have been proposed. However, several key analytical components are missing, including a characterization of optimal methods for policy learning, and sharp bounds for minimax regret. In this paper, we derive lower bounds for the minimax regret of policy learning under constraints, and propose a method that attains this bound asymptotically up to a constant factor. Whenever the class of policies under consideration has a bounded Vapnik-Chervonenkis dimension, we show that the problem of minimax-regret policy learning can be asymptotically reduced to first efficiently evaluating how much each candidate policy improves over a randomized baseline, and then maximizing this value estimate. Our analysis relies on uniform generalizations of classical semiparametric ef- ficiency results for average treatment effect estimation, paired with sharp concentration bounds for weighted empirical risk minimization that may be of independent interest.