As I am flying to the AAOP meeting in Chicago I am reading e-mailing comments on which technology would be appropriate or inappropriate to fit in Haiti. But what is appropriate here? Elevated vacuum has a multitude of advantages for those who have the necessary gadget tolerance to accept it and work with it every day. And if the person lives remotely, it will require more maintenance visits than simpler systems. It will cost more initially and in the long run.  Ethical fitting requires full disclosure of the hassles of elevated vacuum as well as the benefits. I have had 100% success in fitting elevated vacuum to transfemoral amputees. They love it and it improves their life.  I believe the success I have had has to do as much with selecting the patients as with the benefits of the system and with my skills and patience at problem solving. I spend a good deal of time discussing the extra time it will take to apply the prosthesis and the need to maintain and replace liners, sleeves, and valves. And I also make sure that the patient truly has problems with their current prosthesis that warrant dealing with these inconveniences. It is all this due diligence that makes elevated vacuum the appropriate technology for your patient. I’ve got to fasten my seatbelt now.