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The early clinical trials for EndoStim were conducted in India and Chile and are now being expanded into Europe. “What they have in common,” said Hogg, “is superb surgeons with high levels of skill, enthusiasm for the project, an interest in research, and reasonable costs.” What’s in it for America? As long as the venture money, core innovation, and key management comes from this country—a lot. If EndoStim works out, its tiny headquarters in St. Louis will grow much larger. The United States is where the best jobs—top management, marketing, design—and the main shareholders will be, said Hogg. Where innovation occurs and capital is raised still matters.

To go from EndoStim to Eko India Financial Services—humming away in a garage in South Delhi—is to go from the most virtual of startups to the most conventional, but it is still striking how much they have in common. Eko’s founders, Abhishek Sinha and his brother Abhinav, started with the simplest observation: Low-wage Indian migrant workers flocking to Delhi from poorer regions had no place to put their savings and no secure way to send money home to their families. India has relatively few bank branches for a country its size, so many migrants stuffed money in their mattresses or sent cash home through traditional hawala, hand-to-hand networks.

This gave the brothers an idea. In most Indian neighborhoods and villages, there’s a mom-and-pop kiosk that sells drinks, cigarettes, candy, and a few groceries. Why not turn each one into a virtual bank? they asked themselves. To do so, they created a software program whereby a migrant worker in Delhi, using his cell phone and proof of identity, could open a bank account registered on his cell-phone text system. Mom-and-pop shopkeepers would act as the friendly neighborhood banker and do the same, so no new bricks and mortar were needed. Then the worker living in his shantytown around Delhi could give his kiosk owner 1,000 rupees (about $20) and the shopkeeper would record it on his phone and text the receipt of the deposit to the system’s mother bank, the State Bank of India. The worker’s wife back in Bihar could then just go to the mom-and-pop kiosk in her village, also tied in to the system, and make a withdrawal using her cell phone. The shopkeeper there would give her the 1,000 rupees sent by her husband. Each shopkeeper would earn a small fee from each transaction, as would the State Bank of India. Besides money transfers, workers could also use the system to bank their savings.

Eighteen months after opening for business in 2008, this virtual bank had 180,000 users doing more than 7,000 transactions a day through 500 “branches”—those mom-and-pop kiosks—in Delhi, and 200 more in Bihar and Jharkhand, from where many maids and other internal migrants come. Eko gets a modest commission from the Bank of India for each transaction and was already showing a small profit in 2010. Abhishek, who was inspired by a similar program in Brazil, said the kiosk owners “are already trusted people in each community” and routinely extend credit to their poor customers. “So we said, ‘Why not leverage them?’ We are the agents of the bank, and these retailers are our subagents.”

Why not, indeed? The cheapest Indian-made cell phone today has enough computing power to become a digital “mattress” and digital bank for the poor. The whole system is being run out of a little house and garage with a dozen employees, a bunch of laptops, and cheap Internet connectivity. Not surprisingly, the Sinha team began building its own core software with some free, open source code downloaded from the cloud. Realizing that they did not have the capital themselves to invest in large-scale hardware, they run their whole business on cloud-computing servers hosted at a data center in Noida, a suburb of Delhi.

The core idea of the business, says Abhishek, is “to close the last mile—the gap where government services end and the consumer begins.” There is a huge business in closing that last mile for millions of poor Indians, who, without it, can’t get proper health care,