At 25% of the nation's physician workforce, international medical graduates (IMGs) contribute significantly to the U.S. health care system. Beyond their sheer numbers, however, IMGs have played critically important roles, both in aggregate and as individuals. By choosing to pursue specialties less attractive to U.S. medical graduates, IMGs have filled important gaps that otherwise would have seriously compromised the effectiveness of the U.S. health care system. Moreover, individual IMGs have made notable contributions to the improvement of clinical practice, to biomedical and health services research, and to medical education. The Educational Commission for Foreign Medical Graduates (ECFMG), through its certification process, has enabled the best and the brightest medical students from other nations to train in the United States and can take justifiable pride in the undeniably positive impact IMGs have had on U.S. health care. It is imperative to note, however, that while the United States and other developing nations have benefited enormously from this "medical migration," there is considerable concern about the damaging effects on many countries in the developing world. Among the options to consider in offsetting the negative consequences of this so-called brain drain is working to improve the medical education available to aspiring physicians in "donor" countries. In facilitating such a process, the ECFMG and its partner, the Foundation for Advancement of International Medical Education and Research, have the opportunity to amplify their contributions significantly by building on their established programs of international assistance in improving medical education.