Every hour in the United States a clinician makes a new diagnosis of tuberculosis (TB) disease, and 5% to 10% of those newly diagnosed will die. The internist has a critical role in changing the fate of patients who are at risk for TB. More than 80% of TB disease in the United States develops years after infection so there is time to intervene. In the United States, there are 13 million to 14 million persons estimated to be living with latent TB infection (LTBI)1 and it is these persons–often unaware of their infection and untreated–who represent the majority of our TB cases today and in the future. The good news is that TB disease can be prevented through testing and treatment of LTBI. To make TB prevention even simpler, we now have a safer, shorter, effective treatment regimen.2