The incontrovertible scientific evidence about tobacco use causing serious health consequences is now accepted even by the tobacco industry. Research continues to enlarge the spectrum of diseases caused by tobacco use among users as well as among nonusers exposed to secondhand tobacco smoke. This review attempts to illustrate the greater risk to adverse health outcomes among the less educated due to a greater prevalence of tobacco use among them. Numerous surveys worldwide and in India show a greater prevalence of tobacco use among the less educated and illiterate. In a large population based study in Mumbai, the odds ratios for any kind of tobacco use among the illiterate as compared to the college educated were 7.4 for males and 20.3 for females after adjusting for age and occupation. School-dropouts are more likely to take up tobacco use in childhood and adolescence. Student youth taught about the dangers of tobacco use in school are less likely to initiate tobacco use. High tobacco use among the less educated and under privileged affects them in multiple ways: (i) Tobacco users in such households, because of their nicotine addiction, prefer spending a disproportionate amount of their meager income on tobacco products, often curtailing essential expenditures for food, healthcare and education for the family. (ii) Because of high tobacco use and other factors of disadvantage connected with low educational status, they suffer more from the diseases and other health impacts caused by tobacco. This higher morbidity results in high health care expenditures, which impoverish the family further. (iii) Premature death caused by tobacco use in this under- privileged section often takes away the major wage earner in the family, plunging it into even more hardship. Tobacco use is a terrible scourge particularly of the less educated, globally and in India. Tobacco use, education and health in a human population are inter-related in ways that make sufferings and deaths caused by tobacco use even more tragic than normally realized. Tobacco use works against social and economic development and should be appropriately addressed through health education and tobacco cessation services particularly in the underprivileged, illiterate population.