Purpose of Review <p>The global burden of neurocritical illness is high. Low- and middle-income countries (LMICs) are disproportionally affected, with higher incidence, higher severity, limited access to care, and worse outcomes compared to high-income countries (HICs). In this review, we describe the current state of neurocritical care in LMICs, review major challenges and highlight potential solutions.</p> Recent Findings <p>Neurocritical care services in LMICs face significant limitations. Key challenges include inadequate intensive care unit (ICU) infrastructure, limited access to medications, devices, and neuroimaging, a shortage of trained personnel, insufficient prehospital care and transport, and a lack of research and clinical practice guidelines. To address these disparities, targeted interventions are essential. Potential solutions for improving neurocritical care in LMICs include establishing low-cost intermediate care units, developing teleneurocritical care systems to bridge the gap between urban and rural areas, creating cross-border ICU networks, promoting the development of affordable medications, devices, and imaging tools, strategically training specific healthcare workforce, focusing on and building tier 1 emergency medical services, implementing innovative transportation models, establishing local ICU registries, developing context-specific guidelines and protocols, and conducting cost-effectiveness studies that consider the unique needs of LMICs.</p> Summary <p>Multifaceted collaborative efforts and creative solutions are needed to address the challenges unique to neurocritical care in LMICs.</p>