A distance learning nursing course is offered via two-way interactive video and the Internet from the University of North Carolina at Wilmington to nursing students at Mie Prefecture College of Nursing in Japan. The course was designed to teach Japanese students nursing practices and issues in the United States. The classroom environment used a combination of synchronous (two-way interactive video connections over an Integrated Services Digital Network) and asynchronous technologies (electronic mail, Internet-based discussion forums, and World Wide Web pages). Students' course evaluations highlighted areas of success, and pointed out some of the challenges that remain for effective implementation of international education courses.