U.S. foreign aid has reached a crisis point. While the amount of aid has increased in recent years, the way it is organized and delivered by the U.S. government has become increasingly fragmented and chaotic. The proliferation of federal agencies engaged in foreign aid has created serious disconnects and inefficiencies in the use of this important tool of U.S. foreign policy. It is time for a change. Here, two well-known experts who have worked extensively in the international development field provide some keen observations on the current disorganization of federal assistance and offer advice on how to make U.S. aid more effective. Several models for streamlining the organization of foreign aid are detailed and recommendations proffered. The authors argue that dramatic change in the way U.S. aid is organized and provided is urgently needed.