Health care migration is a large and global business. Recruitment is decentralized, involves both public and private sector entrepreneurs, and is difficult to regulate. The countries of the Western Hemisphere are important players in the global health market but, with the partial exception of the Islands of the Caribbean, there is little cooperation among their governments to manage migration patterns or combine forces in order to achieve economies of scale and cost effective training facilities. A related area of concern within the realm of health is care for the elderly. In wealthy countries people are living longer but not necessarily healthy lives and require expanding levels of care as they age. Their care is likely to involve paid service providers who often originate from poorer countries. But the demographic and economic changes in the poorer countries make caring for the elderly more difficult there as well.In the major migrant receiving Western Hemisphere countries, the US and Canada, the concern is that domestically educated nurses will not be sufficient to meet growing demands. The recruitment of immigrant professionals in nursing fields helps fill existing gaps. The pages that follow outline a range of issues related to health care workers from the Western Hemisphere, their patterns of movement, their roles in the work force primarily in the US and Canada, and the impacts of health care migration on source and receiving countries. The study tracks the largest segment of migrating health care workers: nurses and long term/direct care providers who perform nursing functions. It covers training, migration requirements, and ethical issues raised the flight of qualified health care givers and looks at efforts, especially in the Caribbean region to manage that flight.