This article analyses poverty and undernutrition in two of India's poorest states – Orissa and West Bengal. We describe poverty and undernutrition in these two states, focusing on within‐state differences. We argue that the persistence of the differences within Orissa is due to ‘structural inequalities’ in the access to and delivery of central government programmes. We then explore the preliminary evidence on West Bengal's recent efforts to improve service delivery through a programme of decentralisation. The conclusion reflects on the nature of approaches that are needed to ensure programmes work even in the most remote and deprived places.