This article deals with the migration of skilled health professionals (SHPs) in and from eight Pacific island countries (PICs) in the context of the globalization of the health workforce. Although the migration of SHPs is not new, current trends speak of a global migration chain which includes developing and poor countries as a source of SHPs to developed countries. Recent experiences with the migration of SHPs in and from the PICs are elaborated in this article based on a survey undertaken in the PICs in 2000–2002. Income differentials, poor working conditions and the presence of kin in other countries are some of the factors that drive the emigration of SHPs. The operation of these factors, along with the active recruitment of SHPs by the developed countries, suggests that the PICs are likely to continue losing their SHPs, implying difficulties in responding to national health needs.