The acute respiratory distress syndrome (ARDS) causes morbidity and mortality in both resource-constrained and resource-rich settings, but diagnosis, therapy, and research priorities vary with context (Fig. 1). While ARDS exists in resource-constrained settings, it may be under-recognized and under-treated, and is certainly under-studied. This has consequences both for current ARDS patient in resource-constrained settings, as well as future patients who could benefit from context-specific interventions to improve outcomes in ARDS.