Of the 50 million people with epilepsy worldwide, around 80% reside in resource-poor countries, which are ill-equipped to tackle the enormous medical, social and economic challenges posed by epilepsy. The capability to identify people with epilepsy and provide cost-effective care is compromised by widespread poverty, illiteracy, inefficient and unevenly distributed health-care systems, and social stigma and misconceptions surrounding the disease. Several studies have reported that a large proportion of patients with epilepsy in resource-poor countries never receive appropriate treatment for their condition, and many, although diagnosed and initiated on treatment, soon discontinue treatment. The high cost of treatment, a lack of availability of antiepileptic drugs, and superstitious and cultural beliefs contribute to a large epilepsy treatment gap. A substantial proportion of the current burden of epilepsy in resource-poor countries could be minimized by educating the public about positive features of life with epilepsy, informing primary and secondary physicians about current trends in the management of epilepsies, scaling up routine availability of low-cost antiepileptic drugs, and developing cost-effective epilepsy surgery programs. A comprehensive epilepsy care model should consider the marked heterogeneity of the disorder and its variable effects on the patient, family and community.