This study estimates benefits and costs of casino gambling in the state of Iowa. The results indicate that the combined economic impacts of gambling and its ancillary activities are positive overall for Iowa. The measurable benefit–cost ratio for the state is estimated to be between 1.78:1 and 3.18:1. While the majority of Iowans participate responsibly in casino gambling, this study enumerates a prevalence rate of at-risk, problem, and pathological gamblers combined to be between 7.3% and 8.4% of the adult population. This percentage transforms to significant cost approximations. This study further reveals that statewide computation of net benefits is not universal. The differing benefit–cost ratios across casino counties show that not every region is situated to benefit from gambling. Several factors, such as location, resort nature of the casino facility, monopolistic situations, and competitors from out-of-state need to be taken into consideration to understand the benefit–cost dynamics of casino gambling and the viability of future expansion.