Unrecognized malaria in nonendemic regions can have high morbidity and mortality. Distinct patient populations such as travelers, immigrants, and those who visit friends and relatives abroad are at elevated risk for malarial infection. The charts of 63 patients in Dayton, Ohio, for whom malaria smears were ordered from 1999 through 2007 were reviewed. Ten of the 63 patients tested positive for malaria: 5 patients had Plasmodium falciparum, 3 with Plasmodium vivax, and 1 case each of Plasmodium ovale and Plasmodium malariae. The trends among our malaria cases reflect those found nationally. In nonendemic US cities, malaria should be suspected when patients present with posttravel fever; or fever of unknown origin coupled with a background of recent travel or immigration.