The fight against malaria is currently ongoing in many countries where the disease is still endemic. The overall target is to eliminate malaria in all nations, regardless of their malaria burden, by 2030. Currently, the disease has been eliminated mainly in low-burden and unstable malaria areas globally. However, in high-burden countries, particularly in Africa, the disease is still not eliminated; some countries are even recording increases in incidence. This paper discusses why the disease is currently being eliminated in some countries and not in others using a historical and geo-economic perspective. It identifies gaps in the primary contemporary interventions in high endemic areas, particularly in rural constituencies where incidence of the disease is even higher. The key discussion point is that poor housing and behavioral patterns predispose rural dwellers to more malaria. Other risk factors include agricultural occupations, livestock keeping, and the fact that mosquito vectors in Africa thrive more in rural than urban areas. Combating malaria in rural African areas, therefore, requires radical transformative action to address the unique situations that currently enable the persistence of malaria beyond the contemporary, mainly indoor, and health facility-based interventions. Improving housing structures in rural Africa, which are mainly mud and thatched huts, to at least insect-proof standards is the recommended transformative action. Moreover, behavioral patterns, such as cooking outdoors in the evenings, must be modified to cooking in improvised insect-proof kitchens.