In recent years, fourteen percent of the U.S. food supply has been imported from other countries, including many fresh and perishable foods. Although most outbreaks of illness and individual cases are related to foods from the United States, large and unusual outbreaks have been traced to imported foods that were likely contaminated in the country of origin. Investigation of these outbreaks requires collaboration across several disciplines as well as across international borders. Successful investigation can not only control the original problem, but can also inform public authorities in both countries about the need for strategies to prevent similar outbreaks from happening in the future. Production of perishable foods in the developing world brings particular challenges because of the deficiencies in basic sanitation and hygiene and other elements of public health that Americans take for granted. The public health infrastructure in such countries is critical to identifying and controlling foodborne and waterborne challenges before they affect exported foods, and strengthening such infrastructure is an important part of general development efforts. Strategies to improve the health of the workers and rural populations in those countries and to increase the capacity of public health and food safety systems are likely to have long-term benefits to health in those countries, as well as preventing infections in the countries to which they export.