While measuring biomarkers or markers of biological effects may provide more accurate estimates of exposure, collecting these data in the field is often impractical and many methods are not sensitive enough to detect low-level concentrations. Rapid cholinesterase test kits exist to collect blood samples in the field. Conducting large scale assessments of agricultural workers in remote regions of developing countries makes the implementation of these kits a challenge. The cholinesterase assay is a useful clinical tool to assess individual exposure and acute toxicity. However, considerable variability in baseline enzyme activity among individuals makes it difficult to compare field measurements of cholinesterase activity to a reference dose to determine health risk associated with exposure. Another challenge researchers face in deriving a reference dose is identifying health endpoints that are relevant to exposure. More epidemiological research is needed to identify critical health endpoints, particularly among populations who are occupationally exposed.  