Does the way international assistance is organized make sense? Is it working as we mean it to? This book approaches these questions through the experiences of people living on the receiving side of international assistance. It reports on the ideas, insights, and analyses of almost 6,000 people across 20 countries where international aid has been provided. From such a range of locations and people, one might expect vastly different ideas and opinions. However, remarkably consistent patterns and common judgments emerged. In the midst of difference, there was striking unanimity and consistency about the processes and the effects of the international aid system. Using their words, their experiences, and their ideas, this book describes why the cumulative impacts of international aid efforts have not met expectations. It describes a way forward to make changes that, according to those on the receiving end, will lead to more effective and lasting results.