BACKGROUND:Two Australian undergraduate speech pathology students completed a series of clinical placements working with people with complex communication needs in cross-cultural contexts. AIMS:To describe the challenges that the students faced and how best to prepare future students for such experiences. METHODS & PROCEDURES:The students completed the placements in Thailand, Nepal, Bangladesh, India and South Africa. They used personal journaling to record their experiences. The students used the journals as the basis for reflective discussion when considering the challenges they experienced in applying their knowledge and skills. OUTCOMES & RESULTS:The challenges were (1) to prepare adequately ahead of the placements; (2) to select appropriate models of service delivery; (3) to use existing service approaches, resources and infrastructure appropriately; (4) to access professional support; (5) to define their professional role; (6) to manage variable shared language proficiency; (7) to adapt personally; and (8) to work using an undergraduate level of knowledge, skills and experience. CONCLUSIONS:The students encountered challenges related to their clinical preparation and their capacity to adapt in both a professional and personal sense. Future students preparing to undertake such placements need to attain at least minimum clinical competencies before placements. They will be helped if they have some clinical experience in working with people with complex communication needs in cross-cultural contexts, information about the cultures they will visit, and if they set professional and personal learning goals for each clinical placement. This preparation will aid students in maximizing their learning experience.