The significant challenges associated with adapting and delivering the co-design process with Bottom of the Pyramid (BoP) citizens are considered in this article, which tests a new “Empathy Building” step within the Trischler et al. seven-step co-design process model. A sequential, three-study mixed-method research design was applied to co-design a social marketing program with BoP citizens and experts, focusing on the problem of school dropout in a community in South Africa. Study 1 undertook the empathy-building step of the co-design process, which involved a 4-month ethnography in a community in South Africa. This study informed several subsequent co-design steps, including resourcing, planning, recruiting, and sensitizing. Study 2 engaged 38 participants (schoolchildren and parents) in a co-design session, challenging them to create a social marketing program for them and people like them. Study 3 delivered an evaluation session with seven key experts. This article contributes to understanding by offering a process to demonstrate how three studies used the (enhanced) co-design framework to provide a solution for a social issue, namely, prevention of school dropout. Finally, this article outlines how co-design can overcome challenges faced to work with BoP citizens through the addition of ethnography and involvement of experts at the fuzzy back-end of the co-design process to examine program implementation feasibility.