Smoking causes about 20% of United States adult deaths and numerous diseases. Health care for cancer, cardiovascular, and pulmonary diseases from smoking costs tens of billions of dollars per year. Yet those costs are likely far exceeded by costs from bereavement, lost productivity, pain and suffering, and health care for debilities from smoking. Though sometimes more difficult to precisely quantify than costs for fatalities, the lost productivity, suffering, or familial costs of smoking are often much larger, more immediate, and more understandable threats to smokers, their families, and society. This article summarizes qualitative and quantitative human and financial tolls from smoking. The tolls range from cigarette burns, to cigarette ignited fire disasters, to caring for dying smokers and replacing their financial and social contributions to their spouses, children, grandchildren, and the tax base. In the face of such costs, smoking cessation and prevention services are likely to be highly cost-effective.