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The geographic spread and urbanization of visceral leishmaniasis in Brazil has been described since the early 1980s. However, the putative factors associated with this process, its full characterization, and the implications for disease control still challenge researchers and Public Health professionals. Although the available data show that the disease occurs mainly in urban areas, current knowledge is insufficient to claim specificity in urban transmission as compared to rural niches. Transmission scenarios in urban settings appear to be highly heterogeneous, each showing some degree of similarity to the rural epidemiological pattern. The understanding of a relatively recent and complex problem like the introduction, spread, and maintenance of visceral leishmaniasis in urban areas requires new analytical approaches that consider the network of relevant variables and more elaborate methods capable of capturing the dynamics of the environmental and demographic transformations taking place in transmission areas.