Tuberculosis (TB) kills 1.5 million people each year. It is the greatest curable infectious killer worldwide. One-third of the world’s population is infected with the TB bacterium and nearly 9 million people become sick with active TB each year. This document outlines nine project-design challenges most likely to face those working at the community level. This document should be used as a primer for gaining a better understanding of the challenges community-based programs and providers face, as well as some of the ways nongovernmental organizations (NGOs) are currently addressing these challenges. This document is not intended to outline a comprehensive community-based TB effort. There is no right way to respond to the challenges outlined here. The best way to answer them will depend on the nature of your organization and in the setting in which you seek to do this work.