Actress Jennifer Garner takes viewers to Brethitt County in Kentucky, where people are living in poverty and describes how Save the Children is helping in this area. Victoria Beckham also visited the region and reports live to Ryan Seacrest.
Ryan checks in with the contestants, before going over to Pasadena where Queen Latifah introduces The Black Eyed Peas, who perform Rock That Body! After, Ryan talks about malaria killing a person every thirty seconds in Africa and underlines the need for mosquito netting
Ryan reminds everyone that this is indeed a results show, and that they auctioned off the chance to guest host for tonight - a Mr. Lopez won. Comedian George Lopez emerges from the audience! He tells all of the Idol hopefuls to stand up, and then to sit back down, saying it's time to judge the judges for a change!
George Lopez tells Randy that he says 'pitchy' every night, and that people who work at the dog pound don't say 'dawg' as much as him. But Randy is the only brother on the show, so he's safe! Kara is called out for always saying, "I wanted you to make it your own." George mentions her nudie picture from the magazine and says she is safe! Ellen is next in the hot seat. George tells her she is safe, even though they all know she secretly loves Simon! Simon is told to wear a larger t-shirt every now and then, asks, "Saline or silicone?" George tells him that America has voted, and he has to go back to England. However, due to the volcanic ash - he is safe!
Ryan takes over for real results, asking Crystal Bowersox and Casey James to join him in the middle of the stage. Casey is in the bottom three this week, and Crystal is safe. Aaron Kelly and Lee Dewyze are next to stand with Ryan, who tells them that Aaron is in the bottom three, while Lee is safe and will move on. With three still in the dark, Ryan bounces back to Queen Latifah, who introduces a performance by Jeff Beck!
Randy Jackson and Morgan Freeman discuss their trip to Mississippi to see how Save the Children addresses the issue of literacy there. Alicia Keys performs live on the Idol stage, singing Unthinkable and Empire State of Mind Part II.
Carrie Underwood performs Change live. Ellen talks about joining David Arquette in Monrovia California to help at a Feeding America food bank. Ryan talks to Bill Gates and his wife about their foundation to aid global health.
Back to the results, Siobhan Magnus, Mike Lynche, and Tim Urban are asked to join Ryan in the center of the stage. Siobhan is the first to learn she is safe. Mike is also safe, meaning Tim is in the bottom three along with Casey and Aaron!
David Cook joins Ryan to speak about his experiences in Ethiopia and shares a video. Annie Lennox is also featured in a video visiting children with AIDS. Annie performs Universal Child. Mary J. Blige and her All-Star band, including Orianthi, Travis Barker, Steve Vai, and Randy Jackson, perform Stairway to Heaven. Simon reports on Children's Health Fund and his trip to see the charity in action in New York. Simon announces that since the show has been on air they've raised over $15 million! Finally, Queen Latifah introduces Sir Elton John, who talks about his AIDs foundation, and performs Your Song.
Ryan announces that next week will be the songs of Shania Twain, before sending Aaron home to safety. The person leaving American Idol tonight is Tim Urban. Casey is safe and will return next week.