Leishmaniasis is a tropical, subtropical, and Mediterranean disease characterized by a spectrum of clinical manifestations. It is a vector-born disease transmitted by female phlebotomine sandflies, carrying various protozoan parasites from the genus Leishmania that are pathogenic to human hosts. Depending on the location of the parasite in human tissue, it may cause cutaneous, diffuse cutaneous, mucocutaneous, or visceral leishmaniosis, with the latter being potentially fatal to humans. It is currently classified as a neglected tropical disease, being especially prevalent in low-income and developing regions around the world. Concerns over current leishmaniasis treatment cost, safety, and parasite drug resistance have suggested an urgent need to develop an effective vaccine. Advances in understanding of the role of the innate immunity in responding to and directing an adaptive immune response against Leishmania may assist in developing better vaccines. Among cells involved in antileishmanial innate immunity, macrophages act as both a parasite host and killer, releasing proinflammatory cytokines and leishmanicial factors. Other innate cells include neutrophils, which may encourage or inhibit Leishmania pathogenesis depending on the neutrophil type, and dendritic cells, which can link innate and adaptive responses to infection. Knowledge of innate cell activation assists in developing effective adjuvants, with current candidates include TLR agonists, IL-4 and IL-12 cytokines, and sand fly salivary proteins. The relative effectiveness of these adjuvants and their utility given the differential manifestations of leishmaniasis has yet to be fully determined. Understanding T-cell determinants is also necessary to develop vaccines that provide long-lasting protective immunity. Th1 cells, rather than CD8+ T-cells, have been considered a viable target for vaccine strategies given the potential pathogenic role of CD8+ cells in infection and strong immune response mediated by Th1 cells. Uncertainty exists, however, regarding whether nonlive vaccines can sustain sufficient numbers of Th1 effector cells over time. There is also heterogeneity in Th1 cytokine responses depending on the vaccine type. Central memory T-cells and Th17 cells may additionally be effective targets for vaccines, although more research is needed to establish these cells as valid targets.