The dried fruits of large cardamom (Amomum subulatum Roxb.), a high-value, low-volume spice crop grown only in the three eastern Himalayan countries, are widely used in foods, beverages, perfumes, and medicines. Production is currently declining, and improved postharvest management would be one way to help ensure the sustainability of this niche crop. The value chain for large cardamom consists largely of traditional practices; scientific improvements are needed in a number of postharvest steps, including marketing. This article reviews the crop's postharvest processing (with emphasis on curing, calyx cutting, packaging, and storage), quality issues, and trade patterns, and identifies research topics that could contribute to increasing its quality and value and thereby to protecting and promoting the livelihoods of several thousands of people in the value chain.