The election for president, Parliament and local authorities will determine the pace of Serbia's European Union-demanded economic and social reforms, after being an isolated pariah state under Milosevic in the 1990s for his warmongering policies.
The ballots also could determine whether Serbia continues to reconcile with its neighbors and wartime foes, including the former province of Kosovo which declared independence in 2008.
The two leading contenders in presidential and parliamentary elections are Boris Tadic and his pro-EU Democratic Party, and Milosevic's former ally Tomislav Nikolic, whose nationalist Serbian Progressive Party has benefited from the EU's economic troubles, which have dimmed the bloc's allure for many Serbs.
The vote comes amid the country's deep economic crisis - including a 24 percent unemployment rate - and huge public discontent with plummeting living standards.
Nikolic claims to have shifted from being staunchly anti-Western to pro-EU. But that is not taken at face value by many Serbs and Western officials because the former far-right politician only a few years ago stated that he would rather see Serbia become a Russian province than an EU member.
Tadic - considered a moderate - advocates quick EU entry, while Nikolic - who has Russian support - says he wants to see Serbia "both in the West and East."
Nikolic says Serbia should not be an EU member, if the bloc demands that Serbia give up its claim on Kosovo, which is considered the cradle of the Serbian state and religion.
Tensions were high in Kosovo on Sunday as minority Serbs defied ethnic Albanian authorities and voted in the Serbian elections. NATO has recently reinforced its quick-reaction battalion in Kosovo, bringing its total strength to about 7,000 troops, because of the tensions caused by the vote.
Kosovo said it would block voting in local elections in Serb-dominated northern Kosovo, claiming it would undermine its sovereignty, but Serbs there do not recognize the government in Pristina, Kosovo's capital. Kosovo authorities, who are primarily ethnic Albanian, have little authority in northern Kosovo.
Recent pre-election polls have suggested that Tadic's camp trailed Nikolic's bloc by a few percentage points in the parliamentary race, but with the Democrats having better chances of persuading smaller parties to form the next coalition government - just as they did after the election four years ago.
A presidential runoff is expected on May 20, as both Tadic and Nikolic are unlikely to get more than 50 percent of the first round vote that includes 12 candidates.
Tadic's popularity has fallen because of Serbia's economic problems and alleged corruption among the ruling elite. Faced with the global financial crisis, which slowed down much needed foreign investments, his government has seen massive job losses and falling living standards.
Nikolic has gained voter support by criticizing widespread social injustice and for promising jobs, financial security and billions of dollars in foreign investments, if he and his party win the election.