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This thesis is concerned with the question of when the double branched cover of an alternating knot can arise by Dehn surgery on a knot in $S^3$. We approach this problem using a surgery obstruction, first developed by Greene, which combines Donaldson's Diagonalization Theorem with the $d$-invariants of Ozsv{á}th and Szab{ó}'s Heegaard Floer homology. This obstruction shows that if the double branched cover of an alternating knot or link $L$ arises by surgery on $S^3$, then for any alternating diagram the lattice associated to the Goeritz matrix takes the form of a changemaker lattice. By analyzing the structure of changemaker lattices, we show that the double branched cover of $L$ arises by non-integer surgery on $S^3$ if and only if $L$ has an alternating diagram which can be obtained by rational tangle replacement on an almost-alternating diagram of the unknot. When one considers half-integer surgery the resulting tangle replacement is simply a crossing change. This allows us to show that an alternating knot has unknotting number one if and only if it has an unknotting crossing in every alternating diagram. These techniques also produce several other interesting results:
preprint / 2016