Commercial vegetable production in the United States of America (USA) often relies on foliar insecticide sprays for managing key insect pests. However, foliar applications of insecticides have a number of drawbacks to the health of consumers, farmworkers and the environment. Drip chemigation is the application of pesticides to the soil through trickle (drip) irrigation systems, and can overcome a number of the drawbacks typical of foliar insecticide applications. We conducted a two-year study in five commercial fields of staked tomatoes in western North Carolina to compare the efficacy, economics and environmental impact of drip chemigation versus foliar sprays. Drip chemigation significantly reduced insecticide inputs, utilized more selective and environmentally compatible insecticides, and reduced the time lost to reentry intervals, while maintaining comparable efficacy and economic returns. Drip chemigation was an effective tool for managing key insect pests, provided a broad range of human and environmental health benefits, and will likely become increasingly cost-effective in the future as insecticide patents expire and more insecticide options become available.