This study compared road safety and related factors in the U.S. with those in Sweden, the United Kingdom, and the Netherlands, in order to identify actions most likely to produce casualty reductions in the U.S. The reviewed topics were basic country statistics, road fatalities and various fatality rates, national road-safety strategies, and selected road-safety issues. The main differences concerned structural and cultural factors (such as vehicle distance driven), and procedural factors (such as road-safety strategies and targets, alcohol-impaired driving, exceeding speed limits, and use of seat belts). The main recommendations for improving road safety in the U.S. are as follows: (1) lower states’ BAC limits to 0.5 g/l and introduce effective random breath testing, (2) reexamine the current speed-limit policies and improve speed enforcement, (3) implement primary seat-belt-wearing laws in each state that would cover both front and rear occupants, and reward vehicle manufacturers for installation of advanced seat-belt reminders, (4) reconsider road-safety target setting so that the focus is on reducing fatalities and not on reducing fatality rate per distance driven, and (5) consider new strategies to reduce vehicle distance driven.