Smith was scheduled to start in the third preseason game of the 2008 season, but became ill with a rare disease called Lemierre's syndrome. Due to Smith's illness, rookie Joe Flacco was named to the Ravens' starting quarterback position. Early in the season Smith re-emerged in the offense as part of their two-quarterback offense, and was utilized for short-yardage runs. This offense featured Smith lining up at the wide receiver spot as well as under center. Smith appeared in only six of the Ravens' 19 games and had a total of 4 passing attempts for 82 yards in the 2008 season.