We provide a comparative case study of rehabilitation counselling across the U.S., Japan and Taiwan focusing on the common challenges facing international constituents in the field. Through interviews with students, faculty and administrators from each of the respective countries, we use thematic coding analysis to identify key points of tension. Emergent themes comprise (a) systemic challenges, (b) student and faculty mobility, (c) cultural and linguistic differences and (d) lack of sustainable international leadership. We further discuss mitigation of these recurrent challenges and conclude collaborative research, student exchange and institutional partnerships may advance teaching, research and service scholarship of rehabilitation counselling programs, and, in turn, enhance the lives of people with chronic illness and disability worldwide.