Current treatments for the parasitic disease leishmaniasis are unsatisfactory due to their route of administration, toxicity and expense. Resistance is also developing to first-line antimonial drugs. Fortunately, a handful of antileishmanial agents, such as the orally available compound miltefosine, are currently in clinical trials. In addition, several promising drug targets and lead molecules are being studied with the goal of developing new antileishmanial agents. Drug candidates have been identified through the continued investigation of parasite sterol metabolism and parasite proteases. New antileishmanial molecules have also been discovered through the study of novel targets and pathways, such as the bisphosphonate inhibitors of isoprenoid biosynthesis. This review presents a synopsis of the drug targets and lead compounds that have been investigated over the last few years against leishmaniasis, gives a perspective on the chemotherapeutic potential of each and discusses some of the obstacles to antileishmanial drug development.