The Iowa Gambling Task (IGT) assesses decision-making under initially ambiguous conditions. Neuropsychological and neuroimaging data suggest, albeit inconsistently, the involvement of numerous prefrontal cortical regions in task performance. To clarify the contributions of different prefrontal regions, we developed and validated a version of the IGT specifically modified for event-related functional magnetic resonance imaging. General decision-making in healthy males elicited activation in the ventromedial prefrontal cortex. Choices from disadvantageous versus advantageous card decks produced activation in the medial frontal gyrus, lateral orbitofrontal cortex (OFC), and insula. Moreover, activation in these regions, along with the pre-supplementary motor area (pre-SMA) and secondary somatosensory cortex, was positively associated with task performance. Lateral OFC and pre-SMA activation also showed a significant modulation over time, suggesting a role in learning. Striato-thalamic regions responded to wins more than losses. These results both replicate and add to previous findings and help to reconcile inconsistencies in neuropsychological data. They reveal that deciding advantageously under initially ambiguous conditions may require both continuous and dynamic processes involving both the ventral and dorsal prefrontal cortex.