The trade in traditional medicines in South Africa is estimated to be worth R2.9 billion per year, representing 5.6% of the National Health budget. With 27 million consumers, the trade is vibrant and widespread. There are at least 133 000 people employed in the trade, with a large percentage of rural women. The plant trade is a key rural industry and business incubator. However, supply of plant material (some 771 species) and medicines is not sustainable. All plants are harvested from the wild, with popular species becoming locally extinct and being traded at very high prices. Much of the current research and development effort focuses on novel drugs research, with little effort being directed at improving the current harvesting, production, processing, storage and treatment technology. The future of the traditional medicines trade and its benefits are uncertain.