Low-income and underserved geographies are characterized by widespread poverty, ineffective public health and education systems, poor infrastructure coupled with administrative and political apathy. Designing an organizations in such an environment that does good to the community, and is sustainable can be challenging. The chapter examines the functioning of a not-for-profit organization namely, Akhand Jyoti Eye Hospital (AJEH) located in Bihar in India. The hospital through its innovative design elements, structures, and core values, which drives its organizational dynamics, performs large volumes of free eye surgeries for the poor.  AJEH has also made significant social and economic impact in the area of women empowerment and social change through its ‘Football to Eyeball Girls Education Program’. The model of AJEH offers valuable insights into organizational resilience and social enterpreneurship in marginalized areas.