Purpose: This study compared road safety and related factors in the U.S. with those in Sweden, the United Kingdom, and the Netherlands (which are among the best-performing countries), in order to identify actions most likely to produce casualty reductions in the U.S. Method: The reviewed topics were basic country statistics, road fatalities and various fatality rates, and selected road-safety issues. Results: The main differences concerned structural and cultural factors (such as vehicle distance driven), and procedural factors (such as alcohol-impaired driving, exceeding speed limits, and use of seat belts). Conclusions: The main recommendations for improving road safety in the U.S. are as follows: (1) lower states' BAC limits, and encourage the use of alcohol ignition interlocks (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, and (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.