while Lesotho’s agriculture stopped being a source of government revenue more than a century ago, it still fulfilled important household subsistence needs. But even that limited role is threatened as farm sizes and participation rates contract even further in the face of a multitude of factors. At the same time, Lesotho’s population, especially those residing in the lone modern metropolis, Maseru, continues to be more sophisticated, with consumption patterns that are comparable to those in other modern economies. Why is the country’s agricultural sector not rising to the occasion to meet the needs of the growing urban population? The preamble and foreword to the Vision 2020 document tried to address this question but they remain inconclusive. What are the reasons for the poor performance of horticultural products in Lesotho despite growing demand for the products worldwide and in the country? Are there important non-price factors that we should take into account in deciding on appropriate policies for revitalizing the farm sector in a country where few alternative opportunities for employment exist? These were some of the questions this chapter set out to address by examining production and marketing decisions and results in four of Lesotho’s ten districts during 2009. There are indications that property rights, the agricultural extension service and the condition of the physical infrastructure may be crucial elements in finding answers to these problems. The results particularly point to the difficulties in accessing markets and land which remain important institutional constraints to horticulture production and marketing in Lesotho. Recommendations are made for these issues to be incorporated into the Vision 2020 process, among other processes underway to address the growing national food insecurity and enhance livelihoods in general.