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The underground commercial sex economy generates millions of dollars of each year, yet investigation and data collection efforts remain incredibly under resourced. A recent NIJ-funded study aimed to unveil the size and structure of the underground commercial sex economy in eight major U.S. cities—Dallas, Seattle, Washington, DC, San Diego, Denver, Kansas City, Miami, and Atlanta. Across cities, the underground sex economy’s worth was estimated between $39.9 million and $290 million in 2007, but decreased from 2003 to 2007 in all but two cities. Interviews with pimps, traffickers, sex workers, child pornographers, and law enforcement revealed the risks, practices, and relationships central to the underground commercial sex trade—and shaped the policy recommendations to combat it. This paper will discuss the major findings from this study, and the policy and practice recommendations that were identified based on these findings.