This article explores the relationship between gang violence, and the widely varying responses to such violence, in North and Central America. With a specific focus on transnational gangs like the Mara Salvatrucha (MS13) and 18th Street Gang (Calle 18), both of which have their roots in the United States, the author describes the cyclical nature of Central American gang activity and the inter-connectivity between the countries in the region. Emphasizing the important role of prevention programs, as a balance to coordinated rehabilitation and law enforcement efforts, the article argues for a comprehensive approach championed and implemented by the most affected countries in the region, namely the United States, El Salvador, Honduras, Guatemala, and Mexico.