The article describes how economic restructuring in the Dominican Republic during the 1980s and 1990s established the basis for urban food access challenges during the 2000s. Primarily based on research in Santiago, the second largest Dominican city, the article provides insights into how export-oriented development strategies, expanding trade liberalization, domestic political struggles, and patriarchal relations influenced access to food for low-income residents. During the early 2000s, many Santiago residents were engaged in an elaborate, androcentric exchange network that linked gendered income-generating strategies to credit-bearing food merchants who were, in turn, conjoined to a sequence of brokers all of whom were eventually linked to domestic and international producers by credit relations. Analysis of these findings illustrates how and why this exchange network existed, the importance of credit relations to its maintenance, and the ways in which government and U.S. food policies influenced urban provisioning patterns among the most economically and socially vulnerable population of Santiago. I argue that the rapidly changing social and spatial configurations of Latin American and Caribbean cities calls for innovative applied anthropological research into the processes that structure access to food resources by food insecure groups. By focusing on household food procurement in conjunction with exchange relations for a key staple, the article highlights practices and policies that enable and constrain food access for such groups. The article provides empirical data relevant to scholars and practitioners concerned with understanding the structural origins of the present-day food crisis in developing countries.