Socioeconomic poverty makes the people of Palau at a near-critical risk for vulnerability to both natural disasters and to diseases. Chronic diseases, such as heart disease, cancer, and diabetes, top the list of diseases that negatively impact the health of Palauans, and infectious diseases, such as leprosy and tuberculosis (TB), are also quite a problem. Per capita, $881 a year is spent on the health care needs of the citizens of Palau. However, no money has been set aside for the management and treatment of health problems in the indigent people who work temporarily on this island-nation. These temporary migrant workers are often quite poor, have little or no access to medical care while they are in Palau, and are not currently tested for Mycobacterium tuberculosis (MTB) or other diseases when they immigrate to Palau. The prevalence of latent tuberculosis infection (LTBI) and active MTB in this population is currently unknown, and these individuals could pose a great risk to the native Palauan population due to the presence of infectious diseases, including tuberculosis. This report describes a proposed program to test these migrant workers upon entry to Palau for TB and the human immunodeficiency virus (HIV), since it can affect testing results and can change the therapy recommendations for those patients with MTB. If this proposed TB testing program is adopted, the epidemiology of these diseases could be better described. Those identified as having LTBI, active MTB, and HIV could be treated, which could prevent the spread of these diseases to the native Palauan population. If identified early, they could be treated using far fewer funds than would be required should they be identified late in the course of their disease.