Examines the controversial recent history of skilled migration, and explores the economic and cultural rationale behind this rise of a complex global market in qualified migrants and its multifaceted outcomes. Pays particular attention to the increase in demand for migrants in more developed countries due to the complex ramifications of aging, and new opportunities and expectations. The long-established skill-drain, with its impact on household relations and negative consequences for health care, is carefully balanced against new flows of remittances, the return of skills and complex regional changes.