After years of decline, tuberculosis has become an increasing cause of morbidity and mortality in the United States. Chronic problems of poverty, homelessness, substandard housing, and poor access to health care have combined to help maintain a reservoir of infected persons. The addition of HIV-associated immunodeficiency has allowed many of these infected individuals, whose infections ordinarily would have remained dormant, to develop tuberculosis at younger ages. In addition, increasing numbers of cases of tuberculosis are being identified among young foreign-born adults from countries of high tuberculosis prevalence. Transmission from these young adults has occurred in increasing numbers to children. These children form an enlarging pool of infected persons that will continue the cycle of tuberculous infection and disease for future generations. Renewed emphasis and resources need to be placed on tuberculosis, particularly in the public health sector. Only in this manner will early detection and treatment of those with infection and disease occur and the cycle of tuberculosis be broken.