Crops genetically engineered to produce insecticidal proteins from Bacillus thuringiensis (Bt) have advanced pest control, but their benefits have been reduced by evolution of resistance in pests.The global monitoring data reviewed here reveal 19 cases of practical resistance to Bt crops, which is field-evolved resistance that reduces Bt crop efficacy and has practical consequences for pest control. Each case represents the responses of one pest species in one country to one Bt toxin. The results with pink bollworm (Pectinophora gossypiella) and Bt cotton differ strikingly among the world's three leading cotton-producing nations. In the southwestern United States, farmers delayed resistance by planting non-Bt cotton refuges from 1996 to 2005, then cooperated in a program that used Bt cotton, mass releases of sterile moths, and other tactics to eradicate this pest from the region. In China, farmers reversed low levels of pink bollworm resistance to Bt cotton by planting second-generation hybrid seeds from crosses between Bt and non-Bt cotton. This approach yields a refuge of 25% non-Bt cotton plants randomly interspersed within fields of Bt cotton. Farmers adopted this tactic voluntarily and unknowingly, not to manage resistance, but apparently because of its perceived short-term agronomic and economic benefits. In India, where non-Bt cotton refuges have been scarce and pink bollworm resistance to pyramided Bt cotton producing Cry1Ac and Cry2Ab toxins is widespread, integrated pest management emphasizing shortening of the cotton season, destruction of crop residues, and other tactics is now essential.