Lead exposure remains a major issue in cities, such as Buffalo and Rochester, with concentrated, segregated poverty and old, deteriorated housing stock. Exploring and comparing local policies and programs in these two cities, the author suggests that increasing the number of proactive housing inspections in high-risk areas and forming a single-purpose non-profit group dedicated to lead education and advocacy are two valuable interventions. He recommends additional policy steps, such as more stringent inspection standards; state adoption of the Environmental Protection Agency’s Renovation and Repair Program; the lowering of state elevated blood level thresholds; a focus on in-person, interactive education by community health workers; and more vigorous enforcement of testing requirements among physicians.