Many nations in the Western world face nearly unprecedented fiscal challenges, both for the medium and longer term. The Great Recession has added to fiscal pressures and public debt to nations that are already beginning to experience the fiscal fallout from aging populations. Budgeting is clouded by nearly unprecedented fiscal ambiguity, as nations are conflicted between forces demanding fiscal consolidation and those advocating growth and stimulus to jump start stagnant economies. Daunting challenges lie ahead in the next several decades for democratic nations and their leaders. With deficits and debt rising to near record levels in most nations, the recovery from the recession will still leave significant fiscal gaps that must be addressed. As nations cope with the resulting fiscal imbalances, they will also be dealing with longer-term fiscal pressures stemming from the aging of populations and rising health care costs. Unlike previous recessions, the return of strong growth will not end the fiscal gaps facing these nations, but will serve as the prelude for even more difficult and wrenching choices.