Ensuring that advances in genomics are applied to the health improvement of people living in developing countries is an important contemporary challenge. In the near term, such advances are likely to alleviate infectious diseases, with longer-term benefits envisaged for chronic disorders. To ensure that benefits are shared by developing countries, attention must be paid to complex ethical, legal, social, and economic issues, as well as to public education and engagement. Creative and equitable international mechanisms and goodwill are needed to turn high hopes into reality and allow the use of genomics to reduce health inequities between rich and poor nations.