The migration of health workers from Niue is part of a broader migration trend where the national population has declined significantly in the past quarter of a century. This is due to significant social and economic differences with New Zealand, and the shift in population gravity towards New Zealand where most Niueans now live. The impact of migration in isolated Niue was less than in some other Pacific states, measured either as workforce vacancies or inadequate service provision. Niue has retained an effective health workforce because of external conditions: an aid dependence that enables a large public service with most households having two wage earners in the public service. Opportunities for promotion and training, alongside boredom, rather than salaries or standard workplace issues concerned many workers. Small and remote islands such as Niue face the challenge to retain a skilled workforce in the face of high rates of emigration.