Pedestrian needs in crossing streets should be identified, and appropriate solutions should be selected to improve pedestrian safety and access. Deciding where to mark crosswalks is only one consideration in meeting that objective. This study involved an analysis of five years of pedestrian crashes at 1,000 marked crosswalks and 1,000 matched unmarked comparison sites. All sites in this study had no traffic signal or stop sign on the approaches. Detailed data were collected on traffic volume, pedestrian exposure, number of lanes, median type, speed limit, and other site variables. Poisson and negative binomial regressive models were used. The study results revealed that on two-lane roads, the presence of a marked crosswalk alone at an uncontrolled location was associated with no difference in pedestrian crash rate, compared to an unmarked crosswalk. Further, on multi-lane roads with traffic volumes above about 12,000 vehicles per day, having a marked crosswalk alone (without other safety enhancements) was associated with a higher pedestrian crash rate (after controlling for other site factors) compared to an unmarked crosswalk. Raised medians provided significantly lower pedestrian crash rates on multi-lane roads, compared to roads with no raised median. Older pedestrians had crashes that were over-represented relative to their crossing exposure. More substantial improvements were recommended to provide for safer pedestrian crossings, such as adding traffic signals (with pedestrian signals) when warranted, providing raised medians, improving nighttime lighting, speed-reducing measures, and others.