This paper reviews the opportunities and challenges that Eastern African farmers face in accessing domestic, regional and international markets. With rising population and incomes, domestic markets offer great opportunities for farmers. However, because of structural, institutional and organizational constraints, small scale rural farmers may not benefit much from domestic urban markets unless they are organized and trained to meet the high quality product standards demanded by urban consumers and supermarkets. ECA countries stand to gain more by investing in commodities that are consumed within the region, than from traditional cash crops destined for international markets. Regional integration offers opportunities for larger markets and efficiency gains and this is happening, although countries still have to do more to ease the flow of goods across the region, including joint investments in infrastructure to link markets, harmonizing trade policies, and removing trade barriers that limit cross-border trade. Access to international markets remains constrained because of trade distorting practices in developed countries, especially tariff peaks and tariff escalation, domestic support to their farmers, and export subsidies. All these practices render African products uncompetitive, discourage investments in agro-industries, thus limiting growth in jobs and incomes, and slow down the pace of economic growth and overall poverty reduction. African countries stand to gain more from liberal trade policies than from aid from developed countries.