Why are so few organizations selling beneficial products at the base of the pyramid (BoP) successful? This is not simply a story of companies failing, and it is one with a dramatic consequence as low-income people do not benefit from products that can improve their way of life. Instead, they continue to drink unsafe water, cook on stoves that emit fumes that kill over 1 million people per year, light their homes with dangerous kerosene lamps, and fall ill from a mosquito bite. Based on a multiyear field research program conducted in 25 countries, we argue that having a specific mindset about BoP customers is consequential to an organization’s success. Many organizations start with the assumption that BoP customers lack money, knowledge, and jobs. By contrast, successful organizations start from the assumption that customers can and will pay if they are provided with a satisfactory solution to their needs and are reassured about the level of risk involved. We detail the different practices that follow from this mindset change in the areas of value proposition, communication, and distribution and show how these practices can make or break the organization’s financial sustainability.