Sustainable milk production and consumption in low-income countries must address food security and climate change mitigation simultaneously. Socioeconomic sustainability is paramount in low-income countries, where milk production and consumption represent a vehicle to improve human nutrition and health, as well as the potential for economic opportunity and improved livelihood of subsistence farmers. These benefits can only be achieved with judicious use of animal stocks and agricultural practices that do not exhaust available natural resources, which are often shared by regional farming communities. Milk and dairy foods provide variety to the diet and make significant contributions to meeting the needs for high-quality protein, calcium, magnesium, selenium, riboflavin, vitamin B 12 , and pantothenic acid (vitamin B 5 ) in at-risk populations, particularly children, pregnant women, and the elderly. Milk production in low-income countries occurs largely in smallholder mixed crop-livestock systems where animals play multiple roles and may suffer from undernutrition, leading to negligible or no milk production during several months of the year. Non-food roles of livestock include draft, fuel (manure), store of capital, and insurance against crop failure. These roles and the social standing associated with animal ownership may incentivize the maintenance of large herds that place stress on feed (land) and water resources. Under these circumstances, sustainable intensification (i.e., increasing milk production from currently available resources) represents the single most important and practical strategy to improve the sustainability of milk production and consumption in low-income countries. Improving the genetic potential of animals and the availability of quality feed, and providing balanced nutrition are the most promising strategies to improve milk production and sustainability in low-income countries. For example, the deficit for milk in Ethiopia is estimated at 4.5 billion liters/year, which can be closed, in part, with balanced animal nutrition. Milk production in low-income countries will be more sustainable if it relies on natural resources available locally and regionally to supply essential nutrients to at-risk human populations.