The escalating demand for trained direct long-term care (DLTC) workers, those individuals with the most sustained direct contact with vulnerable older adults in homes and facilities, is a consequence of our rapidly aging population. Research documents the present and projected shortages of DLTC workers, and developed nations are increasingly turning to immigrant women to fulfill these workforce needs. The authors identify international trends that influence the availability of these workers. Following a broad overview of the DLTC workforce, they turn to a specific examination of immigrants working in long-term care settings in the United States. The authors raise a number of questions about this changing workforce profile. They outline four ways that institutes of higher education can help improve the DLTC workforce in the United States and suggest that colleges and universities work in partnership with policy makers and the long-term care industry to this end.