Paragonimiasis is an important cause of pulmonary disease worldwide. It results from an infection with Paragonimus, a parasite that reproduces through a complex life cycle involving snails, crustaceans, and mammals. Humans acquire the disease by ingesting uncooked freshwater crab or crayfish. Paragonimus species are distributed globally, and the disease is well known in endemic regions of Asia where culturally based methods of food preparation foster human transmission. Paragonimus also exists in regions of the United States but has been a rare cause of pulmonary disease. We report a case of a previously healthy young man who developed a dense empyema from Paragonimus kellicotti that ultimately required thoracotomy and praziquantel to eradicate his infection.