In this EAST Careercast, an open discourse between Dr. Juan Carlos Puyana and Dr. Gregory Peck, highlights some of the details and challenges to providing International Fellows education and training opportunities in US Acute Care Surgery Fellowships. Given the deficit of Acute Care Surgery education and training globally and the consequential perpetuation of Global Emergent and Essential Surgical burden, the goal of this EAST Careercast is to serve as an introduction for International Fellow applicants and US Program Directors to continue a difficult but necessary discourse. Establishing mechanisms for International Fellows to participate in US education and training fellowships is timely.