Coffee (Coffea spp.) originates from the tropical montane rainforest understorey. In this shaded environment, the coffee plant has co-evolved with a wide array of pests and diseases. The fungal pathogen Hemileia vastatrix is the most notorious of all known coffee plant diseases. With a rich history rooted in colonial trade and power struggles, H. vastatrix has had its lion’s share of research and scrutiny by the plant pathology community. Though this disease was discovered more than 150 years ago, many unknowns concerning its spread and persistence across the tropics still exist today. Despite its relevance to coffee production, there is little global data that synthesizes the impact of this disease on coffee yield and plant health. Best practices for control of coffee leaf rust are contentious. Genetic resistance has been breaking down in cultivars across the coffee belt over the past decade. How can farmers best control outbreaks of the disease? Are these practices at odds with new trends and challenges in coffee farming (e.g. organic, biodiversity-friendly, agroforestry etc.). What are the future prospects of our global coffee supply under pressure from this rampant disease? All these questions are examined in this case study using pertinent literature sources and supplemented by coffee farmers or extension service providers in Latin America and Africa.