Diagnostic imaging has revolutionized modern medicine; however, its availability is limited or non-existent in low- and middle-income countries (LMICs). Though the evolution of minimally invasive interventional radiological procedures has allowed unique therapies to minimize or obviate the need for open surgeries, there remain significant obstacles that must be overcome to safely and practically implement these procedures in LMICs. Careful consideration given to resource allocation, personnel training, and procedural selection is crucial to maintaining a safe and sustainable interventional radiology (IR) practice in underserved regions. Financial requirements may be mitigated by a careful needs-based analysis and reliance on cost-effective modalities. Novel training techniques, like implementation of endovascular simulation training and long-term partnerships with developing institutions, can be used to overcome the limitations of traditional training methods in LMICs. IR practice in diverse environments, such as in combat or in mobile healthcare programs, was used as an early framework for establishing practices in LMICs. Implementation of the more readily available radiological equipment has made interventional procedures possible in underserved regions; commonly performed procedures in high-income nations can be modified to be lower cost with minimal effect on their efficacy or safety. Through careful planning and innovative techniques, local providers in LMICs can have access to the training and equipment necessary to offer lifesaving, minimally invasive procedures. With creative modifications to traditional IR procedures and healthcare delivery, the interventional radiologist can make significant medical contributions to the global community.