The implementation of non-user-centered design is sometimes effective for traditionally mass-produced items; however, these methods do not take into account local needs, resources, and cultures, and the history of individual people and communities in low- and middle-income countries (LMIC). This neglect leads to “specialized” solutions based on a non-representative portion of high-income users, rather than the larger population of potential users, and results in devices that are alienated from the target community. In consequence, the resulting products do not work properly, nor do they have the intended impact. As an example, even if they do work at first, the implementation and maintenance effort and costs are usually so high that they rapidly fall into disuse. This chapter highlights examples of innovative practices of assistive technology based on users’ priorities, which are culturally appropriate and sustainable. The chapter also reviews the shortfalls of well-intentioned “solutions” that fail when they are implemented in the intended population due to the lack of a proper understanding of local context.