An important concern for American retirees living in Latin America is the quality and cost of health care. Indeed, good, low cost health care is heavily promoted as an important amenity for older lifestyle migrants. This article discusses the perceptions of American retirees about the health care services they receive in the private health care system in Cuenca, Ecuador and considers when “shadowing modernity” is important in medical practice and when it is not (Ferguson 2006). In particular, the retiree’s narratives about the care they receive in Ecuador reveals that they have constructed a health care imaginary that privileges caring and personal attention over technological sophistication. The “health care imaginary” expressed by retirees in Cuenca is based in part of their direct experiences as patients or as primary caretakers of patients and in part on their collective imaginations and nostalgia for life in a simpler time and place.