Building an effective child welfare system is a monumental task facing postrevolution Romania. Following revelations on American and Western European television about the large number of "orphans" in Romania, many couples flocked to that country to adopt children. A significant number of adopted Romanian children were brought to the United States. Some of these children are now evidencing problems that are bringing them to the attention of health and social service agencies. This article examines the macroeconomic policies that led to the institutionalization of a large number of children in Romania. Although institutional care is the current norm, a legal basis exists for building family foster care as an alternative. Romania's new adoption law replaces private adoptions with agency-based work. International adoption agencies are involved in developing community-based foster care and permanency planning as part of their work. This article challenges international adoption agencies to use clinical assessments of developmental delays and more rigorous health examinations for children released for adoption.