Transgenic maize and cotton expressing Bacillus thuringiensis (Bt) toxins were first commercialized in 1996. By 2009, Bt crops were planted on ca. 47.6 Mha in 22 countries worldwide, with the USA and Canada accounting for 54% of this area. Resistance (virulence) development in target insect pests is a major threat to the sustainable use of Bt crops. Four major target pests of Bt crops in the USA and Canada – European corn borer, Ostrinia nubilalis (Hübner), southwestern corn borer, Diatraea grandiosella Dyar (both Lepidoptera: Crambidae), tobacco budworm, Heliothis virescens Fabricius (Lepidoptera: Noctuidae), and pink bollworm, Pectinophora gossypiella (Saunders) (Lepidoptera: Gelechiidae) – remain susceptible to Bt toxins after 15 years of intensive use of Bt maize and Bt cotton. The success in sustaining susceptibility in these major pests is associated with successful implementation of the ‘high-dose/refuge’ insecticide resistance management (IRM) strategy: (i) Bt crop cultivars express a ‘high dose’, (ii) initial frequency of resistance alleles is very low, and (iii) a refuge is maintained nearby in the environment. Field resistance (including control failure) to a Bt crop has been clearly documented in three situations: fall armyworm [Spodoptera frugiperda JE Smith] in Puerto Rico, African stem borer [Busseola fusca Fuller (Lepidoptera: Noctuidae)] in South Africa, and P. gossypiella in India. Factors associated with these cases of field resistance include: failure to use high-dose Bt cultivars and lack of sufficient refuge. These observations support the claim that implementation of the ‘high-dose/refuge’ IRM strategy has been successful in substantially delaying field resistance to Bt crops.