Functional approaches to disability measurement in Zambia reveals an overall disability prevalence rate of 13.4%, 4% of whom are recorded as having “speech impairment” (Zambia Federation of the Disabled [ZAFOD], 2006). Further, multidimensional poverty assessments indicate that 48.6% of Zambia's approximately 16 million citizens are impoverished. Currently, there are three internationally qualified speech-language pathologists (SLPs) providing services within Zambia's capital city, Lusaka. Given these statistics, it follows that a significant number of Zambian's, experiencing communication disability, are unable to access specialist assessment and support. Over the past decade, Zambia has seen two very different approaches to address this service gap—firstly, a larger scale top-down approach through the implementation of a formal master's degree program and more recently a smaller scale, bottom-up approach, building the capacity of existing professionals working in the field of communication disability. This article provides an overview of both programs and the context, unique to Zambia, in which they have developed. Authors describe the implementation challenges encountered and program successes leading to a discussion of the weakness and merits to both programs, in an attempt to draw lessons from which future efforts to support communication disability and SLP service development in Majority World contexts may benefit.