Significant progress has been made since the concept of molecular epidemiology of rickettsial diseases was introduced. Molecular tools have been developed and applied to pathogen discovery, tracking the source of outbreaks and assessing the relative risk of different rickettsial agents to public health worldwide. However, there is an emerging need for further development of simple, robust, cheap, and appropriate approaches to agent detection and disease diagnosis platforms. The continuously growing list of new rickettsial pathogens requires renewed efforts by experts in different specialties to understand the biology and ecology of these organisms and the diseases they cause. This basic information is needed to develop comprehensive approach to the modern surveillance, diagnosis, prevention, and control of rickettsial diseases.