In the Asymmetric Traveling Salesperson Problem (ATSP) the goal is to find a closed walk of minimum cost in a directed graph visiting every vertex. We consider the approximability of ATSP on topologically restricted graphs. It has been shown by [Oveis Gharan and Saberi 2011] that there exists polynomial-time constant-factor approximations on planar graphs and more generally graphs of constant orientable genus. This result was extended to non-orientable genus by [Erickson and Sidiropoulos 2014]. We show that for any class of \emph{nearly-embeddable} graphs, ATSP admits a polynomial-time constant-factor approximation. More precisely, we show that for any fixed $k\geq 0$, there exist $α, β>0$, such that ATSP on $n$-vertex $k$-nearly-embeddable graphs admits a $α$-approximation in time $O(n^β)$. The class of $k$-nearly-embeddable graphs contains graphs with at most $k$ apices, $k$ vortices of width at most $k$, and an underlying surface of either orientable or non-orientable genus at most $k$. Prior to our work, even the case of graphs with a single apex was open. Our algorithm combines tools from rounding the Held-Karp LP via thin trees with dynamic programming. We complement our upper bounds by showing that solving ATSP exactly on graphs of pathwidth $k$ (and hence on $k$-nearly embeddable graphs) requires time $n^{Ω(k)}$, assuming the Exponential-Time Hypothesis (ETH). This is surprising in light of the fact that both TSP on undirected graphs and Minimum Cost Hamiltonian Cycle on directed graphs are FPT parameterized by treewidth.