This article compares different ways that countries have regulated paid loot boxes. It also emphasizes the importance of a public health approach to loot box regulation. Only a few countries have taken steps to regulate loot boxes. For example, Belgium has technically “banned” paid loot boxes. In China, video game companies have to include a disclosure of the probabilities of receiving potential rewards. Other countries, including the United Kingdom, are taking a wait-and-see approach. Industry self-regulation has also been adopted. But this seems to have lower rates of compliance than national legal regulation. This article suggests that other public health approaches to loot box regulation can be considered. For example, placing limits on loot box spending and modifications to loot box design.