Gamma-ray observations in the medium energy range (0.50-50.0 MeV) are central to unfolding many outstanding questions in astrophysics. The challenges of medium-energy gamma-ray observations, however, are the low photon statistics and large backgrounds. We review these questions, address the telescope technology requirements, and describe our development of the 3-Dimensional Track Imaging (3-DTI) Compton telescope and its performance for a new mediumenergy gamma-ray mission. The 3-DTI is a large-volume time projection chamber (TPC) with a 2-dimensional gas micro-well detector (MWD) readout.