The World Health Organization estimates that international donors fund nearly 80% of health care equipment in developing countries. Almost 70% of the donations are not in use because of lack of maintenance or spare parts, or because local personnel do not know how to use it, representing a tragic waste of scarce resources. This disconnect arises because of the substantial differences in resources, infrastructure, social and behavioral norms, and the healthcare environment. The typical biomedical engineer in the U.S. is unlikely to be familiar with the unique challenges of designing devices for resource-constrained environments. We have developed a structured methodology that takes into consideration pertinent anthropometric, contextual, social and economic considerations in the design of biomedical devices. This systematic approach involves a series of questions and real-world examples to aid in design exploration and ensure that every decision made in the design process can be defended by a well-informed rationale.