Advances in molecular diagnostics have led to improved stratification and targeted interventions in the treatment of children with brain tumors. This has necessitated complex infrastructure to deliver all the required testing in a clinically useful time period. However, in less-resourced countries, this testing is not routinely available and an ever-widening gap in the ability to deliver more tailored therapies including targeted agents is increasingly evident. This article reviews the recent advances and suggests practical ways of ensuring that genomic advances are applied according to available resources.