The current demand for housing worldwide has reached unprecedented levels due to factors such as human population growth, natural disasters, and conflict. This is felt no more so than in developing countries which have experienced disproportionate levels of demand due to their innate vulnerability. Many current approaches to housing delivery in developing countries continue to utilize inappropriate construction methods and implementation procedures that are often problematic and unsustainable. As such affordability and sustainability are now vital considerations in the international development debate for housing the poor in developing countries in order to meet the long-term sustainable development goals and needs of housing inhabitants. This paper utilized an extensive scoping study to examine the various facets impacting on design decision-making relative to sustainable and affordable housing delivery in developing country contexts. Aspects of affordability, sustainability, design decision-making, appropriate technology use, cultural awareness, as well as current barriers to affordable and sustainable construction in developing countries are examined in detail. Results highlighted the capability of indigenous knowledge, skills, and materials as well as selected appropriate technology transfer and cultural awareness by foreign bodies can be utilized in innovative ways in addressing current housing needs in many developing country contexts.