The future of the tobacco-produced disease epidemic rests in low- and middle-income countries, where cigarette sales are growing-the result of rising incomes, trade liberalization, liberalization of the treatment of women, and the introduction of Western-style advertising. Research on disease causation, epidemiology, and educational and policy interventions has contributed significantly to reducing smoking rates in developed countries. A similar contribution is needed in less affluent nations, but severe challenges are involved in implementing a robust research program in such countries. In an attempt to understand these challenges and begin to conceptualize an approach to overcoming them, I examine the need for and methods to achieve a program of meaningful research on tobacco and health, as well as health policy, in the developing world.