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Volunteering internationally appeals to health care professionals and students for a variety of reasons and serves a number of purposes. If international voluntarism is to be mutually advantageous, however, host countries, volunteers and project sponsors need to understand how best they can work together and what can be achieved by volunteers for the greatest benefit of all concerned. This paper is intended to contribute to the growing dialogue on international voluntarism and offers suggestions to strengthen its value, from the perspectives of health workers in a developing country and the authors' experiences over the past 30 years. The paper also identifies undesirable side effects and disabling interventions of international initiatives and examines the notions of aid and assistance. One strategy to prepare volunteers for upcoming international efforts as well as to address inequities at home is involvement with underserved populations in our own country.