Bed bugs, Cimex lectularius L. (Hemiptera: Cimicidae), are a fast-growing urban pest of significant public health importance in the United States and many other countries. Yet, there is very little field research on the ecology of this pest due to its near absence in the United States and most developed nations for several decades. We investigated characteristics of the bed bug infestation and dispersal in a 223-unit high-rise apartment building through visual inspections, intercepting devices, and resident and staff interviews between December 2008 and April 2009. The following results were obtained: 1) 101 apartments (45% of the high-rise building complex) experienced bed bug infestations (within 41 mo of the first confirmed introduction), 2) 78% of the bed bugs trapped were nymphs, 3) an average of six bed bugs were detected dispersing through apartment entry doors every 4 wk, 4) adult bed bugs were 9 times more likely to disperse than nymphs, 5) 53% of apartments adjacent to infested apartments also were infested, and 6) 50% of the interviewed residents who had infestations were unaware of the bed bugs in their apartments. In addition to active dispersal, several passive bed bug dispersal mechanisms were observed: bringing bed bug-infested furniture into the building, travel, resident turnover, resident visits, and use of a bed bug-infested wheelchair in building common areas. These findings validate an urgent need for public education, early detection, and adoption of more effective bed bug monitoring and intervention programs to curb the exploding problem of bed bug infestations.