The history of the Russian tuberculosis (TB) program, dating from the second part of the 19th century until today, is presented, and its achievements and failures are analyzed. The epidemiology of TB is described, and the effects of the TB program initiatives are described and analyzed. Multidrug-resistant TB and HIV coinfection represent severe threats to TB control effectiveness in Russia. New TB control strategies in the present-day epidemiological climate call for important shifts in TB facilities' networking, diagnosis, and treatment approaches.