This case of cleft lip and palate repair by a surgical mission team is common. Low-risk, single-procedure surgical interventions requiring minimal follow-up with substantial quality of life improvement are well suited for this type of mission. However, cleft repair can also be quite complex and require multiple surgeries and other care over time, postoperative surveillance, and speech therapy. These benefits and burdens prompt us to investigate, from clinical and ethical perspectives, whether and when some surgical care is better than none. We argue that, when performing surgical interventions in low-and middle-income countries, mission teams should consider a systems-based approach that emphasizes collaboration, context, and sustainability. Case JJ was born with a cleft lip and palate. As a result, he has developed problems with oral competence, feeding, speech, and social acceptance-due to his appearance. He is 4 years old and lives in a rural community in Central Africa. JJ's family heard that a group of surgeons from a university in the United States were coming to a nearby town to offer free cleft lip and palate repairs. JJ and his family and siblings traveled an hour to seek care, and JJ's family waited all day to finally see the surgeon and resident physicians who repaired JJ's cleft.