In 2012, a total of 9,951 new tuberculosis (TB) cases were reported in the United States, an incidence of 3.2 cases per 100,000 population. This represents a decrease of 6.1% from the incidence reported in 2011 and is the 20th consecutive year of declining rates. Of the 3,143 counties in the United States, 1,388 (44.2%) did not report a new TB case during 2010-2012. This report summarizes provisional TB surveillance data reported to CDC's National Tuberculosis Surveillance System in 2012. The TB rate in foreign-born persons in the United States was 11.5 times as high as in U.S.-born persons. In comparison with non-Hispanic whites, TB rates among non-Hispanic Asians, Hispanics, and non-Hispanic blacks were 25.0, 6.6, and 7.3 times as high, respectively. Although the number of cases dropped below 10,000 for the first time since standardized national reporting of TB began in 1953, a number of challenges remain that slow progress toward the goal of TB elimination in the United States. Initiatives to increase TB awareness and testing and treatment of latent infection and disease will be critical to TB elimination efforts, especially among foreign-born populations, racial/ethnic minorities, and other groups that are disproportionately affected.