Tobacco use is not an equal opportunity killer. Smoking prevalence is increasingly concentrated in populations that may face barriers to quitting. These include persons with behavioral health conditions (mental health illnesses or substance use disorders); persons of low socioeconomic status; persons who are LGBTQ; American Indians/Alaska Natives; recent immigrants from countries with a high smoking prevalence; residents of the South and Midwest; and persons with disabilities. These populations also exhibit lower rates of cessation, partly due to less health insurance coverage. While there have been declines in both youth and adult tobacco use in America, gaps in health equity persist. These trends are well documented, having been the subject of many policy statements, academic analyses, and the subject of the 2020 Surgeon General’s report on Smoking Cessation.