In thinking about the practical application of stem cell biology to clinical situations—particularly for the central nervous system (CNS)—it is instructive to remember that the neural stem cell (NSC) field—as a prototype for somatic stem cells in general—emerged as the unanticipated byproduct of investigations by developmental neurobiologists into fundamental aspects of neural determination, commitment, and plasticity. Stem cell behavior is ultimately an expression of developmental principles, an alluring vestige from the more plastic and generative stages of organogenesis. In attempting to apply stem cell biology therapeutically, it is instructive always to bear in mind what role the stem cell plays in development and to what cues it was “designed” to respond in trying to understand the “logic” behind its behavior (both what investigators want to see and what investigators do not want to see). Furthermore, in transplantation paradigms, the interaction between engrafted NSCs and recipient host is a dynamic, complex, ongoing reciprocal interaction where both entities are constantly in flux. In this review, we propose a “roadmap” to the clinic, with a particular emphasis on flagging the “potholes” and “speed bumps” through which we must navigate. Despite the admonitions to be circumspect, we also suggest disease processes that may be within the grasp of proven stem cell properties and might be approachable in the relatively near future. © 2004 Wiley-Liss, Inc.