A mass fatality incident occurs when a disaster causes many deaths and the affected country does not have sufficient resources to process the remains of victims. The January 12, 2010 earthquake in Haiti was one such event; the estimated 316,000 deaths overwhelmed the response system of the government. The purpose of this article is to review the challenges relating to mass fatality management in this incident. Findings were collected through interviews of 28 individuals along with personal observation obtained during two visits to Haiti after the earthquake. The article argues that a good understanding of these challenges (eg, aftershocks, debris, movement and tampering with bodies, lack of resources, environmental factors, smell of decomposing bodies, threat of epidemics, unidentified bodies, psychological stress, and looting) is crucial for an effective response and quick recovery in communities affected by mass fatality incidents.The article concludes with recommendations for addressing these challenges.