This chapter explores the significant reliance of the United States on internationally educated nurses (IENs) to address its long-standing nursing shortage. It highlights the factors driving nurse migration to the USA since World War II and examines the largely unregulated and privatized nurse recruitment industry. The chapter outlines the challenges faced by IENs, including immigration and licensure hurdles as well as exploitative contract practices. It also examines the ethical concerns surrounding the recruitment process, particularly the impact of “brain drain” from lower-resource countries and the social and workplace integration of IENs. Recommendations are meant to ensure ethical recruitment, fair treatment, and comprehensive support for these nurses. Ultimately, the chapter advocates for policy reforms and ethical standards that promote balanced nurse migration, benefiting both sending and receiving countries while addressing the nursing workforce shortage in the USA.