Recent epidemiological indicators of tuberculosis (TB) indicate that the Millennium Development Goal of TB elimination by 2050 will not be achieved. The majority of incident cases are occurring in population-dense regions of Africa and Asia where TB is endemic. The persistence of TB in the setting of poor existing health infrastructure has led to an increase in drug-resistant cases, exacerbated by the strong association with human immunodeficiency virus coinfection. Spreading drug resistance threatens to undo decades of progress in controlling the disease. Several significant gaps can be identified in various aspects of national- and international-directed TB-control efforts. Various governing bodies and international organizations need to address the immediate challenges. This article highlights some of the major policies that lawmakers and funding institutions should consider. Existing economic and social obstacles must be overcome if TB elimination is to be a reachable goal.