In 2007, a total of 13,293 tuberculosis (TB) cases were reported in the United States; the TB rate declined 4.2% from 2006 to 4.4 cases per 100,000 population. This report summarizes provisional 2007 data from the National TB Surveillance System and describes trends since 1993. The TB incidence rate in 2007 was the lowest recorded since national reporting began in 1953. Despite this overall improvement, progress has slowed in recent years; the average annual percentage decline in the TB rate slowed from 7.3% per year during 1993-2000 to 3.8% during 2000-2007. Foreign-born persons and racial/ethnic minorities continued to bear a disproportionate burden of TB disease in the United States. In 2007, the TB rate in foreign-born persons in the United States was 9.7 times higher than in U.S.-born persons. TB rates among Hispanics, blacks, and Asians were 7.4, 8.3, and 22.9 times higher than among non-Hispanic whites, respectively. In 2007, foreign-born persons accounted for a majority of TB cases among Hispanics (77.2% [2,942 of 3,812]) and among Asians (96.1% [3,261 of 3,393]), whereas U.S.-born persons accounted for a majority of TB cases among blacks (71.2% [2,439 of 3,427]). Among U.S.-born racial and ethnic groups, the greatest disparity in TB rates was for U.S.-born blacks, whose rate remained nearly eight times that of U.S.-born whites. The slowing decline in TB incidence and persistent disparities between U.S.-born and foreign-born persons and between whites and minorities threaten progress toward TB elimination in the United States. The strategic plan for the elimination of TB issued in 1989 by CDC and the Advisory Committee for the Elimination of Tuberculosis set a goal of TB elimination (i.e., less than one case per 1 million population) by 2010 and an interim target case rate of 3.5 per 100,000 population by 2000.