About two-thirds of the 7.4 billion people living on the planet take household toilets for granted. The other third, 2.4 billion people, do not have access to safe sanitation. This chapter aims to bring this reality into the light of day, with the intention of engaging business and management education in the challenging work of providing safe sanitation. It focuses on toilets and the millions of people among the urban and rural poor who are forced to resort to makeshift solutions. The chapter summarizes the current reality and consequences for public health and analyzes the root causes of the sanitation problem especially as experienced by the urban poor. It then looks at business opportunities that could help address the problem and implications for the curriculum for business and management education. Septic tanks offer a sanitary solution that can be good for the environment if the tank is emptied often enough, is treated properly, and if groundwater conditions are suitable.