Similar to the "Doughnut City" concept, previously used to describe booming economic centers surrounded by concentrated pockets of poverty, some patient groups have access to state of the art treatment while other more vulnerable populations lack access to standard of care therapy. This is not only an issue in urology but most fields of health care. My focus is urologic care in medically underserved communities, a dilemma international in scope, which we must “think globally and act locally” to address.Expertise• Access to care• Health care disparities• Treatment of urologic malignancies• Community engagement