Bladder exstrophy epispadias has an incidence approximated as 1 in 50,000 births, rendering the anomaly relatively rare in parts of the world with falling birth rates but equally more prevalent where birth rates are high. Where birth rates are high, economic disparities often mean that exstrophy affects populations least able to access adequate and safe care for bladder exstrophy and epispadias. Equally, the lower incidence in communities with higher economic resources often means that surgeons have reduced exposure to bladder exstrophy and are left less prepared to address and improve outcomes, since increasing volume improves outcomes. In this chapter, we detail one model: the US-India Bladder Exstrophy Collaboration that is based at the Civil Hospital in Ahmedabad, India. This model of collaboration is predicated on a highly experienced and competent host institution that offers health care without cost and is resourced to ensure adequate patient follow-up, collaborating with multiple US and Canada-based children’s hospitals that come together at an annual “workshop” to treat, teach, and investigate bladder exstrophy. We detail herein the nuts and bolts of such a collaboration and the precautions and proactive considerations required to ensure a safe and successful endeavor that addresses the global burden of surgical disease.