In the early evening, as the sun starts to sink over the coffee farms and flower plantations, Robert Lawrence likes to stroll along the river that bisects the town of Boquete. A tall, 67-year-old Texan with silver hair and a friendly smile, he has made his home in this mountainous region of Panama for the past four years. As he meanders along the cracked walkway, he notes the flashy new condos sprouting up on the hillsides, built by foreign investors to meet the influx of American retirees.

The numbers of migrating retirees have swelled in recent years, transforming this scenic hamlet of 20,000 in fundamental ways. For years, Boquete’s primary business was agriculture; today it is also tourism. As many as 20 percent of the town’s residents are “expats,” as they call themselves, although they are more accurately described as immigrants or economic “refugees.”

“Property taxes here are almost nil and health care is actually affordable,” says Lawrence. “They have something called a ‘Pensionado Visa,’” he continues with enthusiasm. “If you’re a foreigner and can prove a certain amount of income, you get immediate permanent residency and discounts on everything from restaurant meals to transportation to health care. That’s a real draw.”

The program, in fact, allows anyone over the age 18 who is receiving a minimum of $1,000 per month, or who invests a minimum of $100,000 in real estate, to access a wide array of discounts, including half-price movies and hotels, 25 percent off utility bills, and reductions on medical and dental care. Panama introduced the visa in 2012, as a way to help replace the flow of expatriate money that had helped fuel the economy until the American military withdrew in 1999. As a consequence, affluent foreigners may now pay less for many goods and services than the Panamanian housekeepers and gardeners in their employ. To further sweeten the pot, some banks and shops have special pensioned sections, so those who hold the visas get served quicker.

Panama wasn’t the first Central American country to set about luring retirees from the North with promises of perks and discounts. Costa Rica pioneered the idea in the 1980s and 1990s, setting off the first post-retirement rush. Since then, so many middle-aged and older Americans have been moving south of the border that many observers have begun referring to Central America as “the new Sun Belt.” With retirement becoming ever less affordable in the United States, locales where costs of living and heath care are low are increasingly attractive.

Though estimates vary, with some observers suggesting that as many as 1.4 million American retirees now live overseas, official reports suggest the number to be around 600,000. Popular destinations include Belize, Tamarindo (also known as Tamagringo) in Costa Rica, San Miguel de Allende and Lake Chapala in Mexico, and Cotacachi and Cuenca in Ecuador. In 2015, International Living, a magazine that serves the expat retiree market, named Panama the number-one destination for offshoring seniors.

But while magazines such as International Living are boosters for the transnational lifestyle, things are a bit more complicated on the ground. Health care, particularly for seniors with complex medical conditions or impaired mobility, may not be as comprehensive as that in the United States. Wills and estate plans drawn up in the States may have no validity overseas without careful shepherding. And for those with no familiarity with their adopted country or its language, a move overseas can result in feelings of confusion, alienation, or even hostility toward the new locale and its citizens.

Things are more complex for host countries, too. The rapid influx of Americans can lead to economic chaos, fueling dynamics of economic inequality and dislocation.

“A bag of rice used to cost $10, now it costs $44,” says Hector Sandoval, assistant manager at a coffee farm in the hills above Boquete. “On the weekends, my whole family used to get together and go to a restaurant. But they’ve raised their prices.” His voice turns bitter. “Most of the restaurants are just for the tourists.”

* * *

On this balmy night in late March, Bob Lawrence is joined by Connie Zielinski. The pair got to know each other through their participation in the English-language community-theater group—one of the dozens of activities for the large English-speaking community.

In the theatrical production, Lawrence and Zielinski played a couple, but in real life they are just good friends, bantering like siblings. They share a taste for adventure. Both unexpectedly also found love in Boquete—Zielinski with a widowed real-estate developer from Naples, Florida, and Lawrence with a Panamanian woman who enrolled in the English as a Second Language class he teaches at a local community center.

Lawrence and Zielinski’s conversation frequently turns to current affairs. They share a kind of “outsiderism”—a skepticism about many aspects of American life, including institutional pillars such as big banks, politicians, and media.

When Lawrence was younger, he held a steady corporate job. When he was laid off, he went back to school for his real-estate license. But the economic downturn of 2008 had consequences for his new career. “People couldn’t get loans,” he says. “I didn’t make a sale for 18 months.”

Divorced and approaching retirement age, Lawrence realized that his Social Security check simply wasn’t enough to sustain him in the United States. “There were a lot of changes to the economy in the ’70s, ’80s, and ’90s,” he says. “If you’re 50 or 60 years old, nobody wants to hire you. And my Social Security doesn’t cover the cost of living in Houston. If I was there, I’d be standing all day on the concrete floor of a Walmart or an Amazon warehouse, just trying to make ends meet.”

“The difference is,” Zielinski shoots back, “instead of just accepting what was handed to you, you said, ‘I’m out of here, I’m moving to Panama.’”

“Yep,” Lawrence says. “You’re right about that.”

Zielinski’s motivation to move was also prompted by financial concerns, and it points toward one of the strains facing America’s baby-boom generation. Tasked with caring for their parents, who are living longer with complicated health conditions, even as they themselves enter older age, boomers find their financial resources are uncomfortably stretched. A businesswoman from Seattle, Zielinski had acquired some measure of financial security, and owned a home on Bainbridge Island. But her 90-year-old mother, who is disabled and lives with her, requires round-the-clock assistance. The cost of private, 24-hour at-home care—which can exceed $500 per day in the United States—was depleting Zielinski’s resources quickly.

Zielinski, who is devoted to her mother and committed to helping her age with dignity, refused to consider a nursing facility. Instead, she slashed her burn rate by moving to Boquete, renting a two-story, four-bedroom condo for $2,500 a month, installing her mother on the first floor, and hiring a live-in caregiver for $100 per week—a fraction of what it would cost in the United States.

The condo is located in one of Boquete’s gated developments, which includes a verdant golf course and spa facilities. Expansive picture windows offer views of the mountains rising in the distance.

“I couldn’t do this in the US,” Zielinski says. “Home care in the US is so expensive, there would have been nothing left for my own retirement.”

Zielinski is typical of the demographic thundercloud on the horizon. The number of retired people will be growing dramatically as a proportion of the population. According to a 2010 US Census study, the number of Americans aged 65 and older is expected to increase to 55 million by 2020, to 70 million by 2030, and to 88.5 million in 2050. At the same time, retirement savings are going down, even as the costs of health care and elder care are rising.

Michelle Putnam, associate professor and associate dean of research at Simmons College and a widely recognized expert in disability, aging and policy, notes that, contrary to the stereotype of boomers as an affluent generation, most of them have little savings. “They were the generation that switched from ‘defined benefit’—the old-fashioned pension being paid into by employers—to 401(k)s, which was supposed to replace the pensions [but] puts the burden on the individual, and that has not been a resounding success.”

Rising costs of housing and social norms that discouraged savings have also contributed to the lack of a nest egg. “Boomers’ retirement savings, on average, is about $50 grand,” says Putnam. “And then, you have coming up behind them a generation that has massive student debt. The boomers didn’t save, and their millennial kids have student loans. The idea of kids helping their parents in the future, or transferring their funds into their parents’ care, is probably unrealistic. So the issue of retirement and money will be huge.”

The rising cost of health care is the other side of this daunting challenge. “We are medical refugees,” says Peter Wendt, who moved to Panama City with his wife from California nine years ago when both were still in their early 60s. (They now live in Boquete.) “Our decision to move abroad was twofold: to live a great quality of life at minimal cost, and most importantly, to find excellent health care at minimal cost.”

As an example, Wendt describes the care his mother-in-law, who moved to Panama with them, received after she fell and broke a hip. “The fee for the doctor and his assistants here was $2000. It would have been ten times that in California.”

The challenges intensify as family caregivers are increasingly in short supply. “Historically, elder care has been mostly by daughters and spouses—so it’s invisible work,” says Putnam. “But with families increasingly reliant on women’s earnings, those women today can’t just drop everything and care for their parents. So those parents are going overseas where their dollar buys them more.”

Cultural changes in America, too, represent a challenge for increasing numbers of American’s elders. In discussion with older Americans living abroad, a theme that comes up repeatedly is a concern for the way elders in the United States are increasingly relegated to the margins: warehoused in institutional facilities, segregated from the rest of US society, cared for by a rotating army of underpaid workers, stripped of their independence and humanity. Their diminished lives are a rebuke to our collective insistence on an ethos of rugged individualism.

Plenty of commentators and policymakers acknowledge that there is a looming problem. But as Putnam observes, “Policy initiatives to address the problem of long-term aging in the US have floundered.”

* * *

The difficulties of old age are among the markers of inequality in the United States. But offshoring elders are leaving one kind of US inequality to be the beneficiaries of another kind globally. For some, it’s a labor issue. Elder care is very labor-intensive, and that kind of labor comes much cheaper in less affluent countries. In the United States, a professional caregiver can charge between $22 and $35 an hour. In Panama, a full day of work can cost less than that.

But the inequality goes deeper. An influx of foreigners changes local economies in some unsettling ways. Reinaldo Carrillo, a 70-year-old taxi driver, says, “Salaries are going up, but not fast enough. The cost of the land is going up, and not just in places where extranjeros [foreigners] live. It is rising everywhere.”

Carillo also has the sense that Americans move to Panama without developing a sufficient respect for the country and its norms. “They don’t bother to learn the language,” he grumbles. “They should learn it. It’s easy to learn Spanish here, because that is the language that everyone speaks.”

Greta Earle, a Panama City native who owns a travel company with her husband, points out that the sheer numbers of American immigrants have pushed up real-estate prices, pushing home ownership out of reach for many young Panamanian families.

“Because of the Canal and through military bases, we Panamanians are very familiar with the culture of the US,” she says. “The difference now is that Americans are not just moving to the cities. Retirees are going to a lot of the smaller towns. Places that were once just tourist attractions are now places to live.”

As a consequence, she says, Panamanians are squeezed. She also expresses concern that Pensionado Visa has created an unfair pricing structure for goods and services, privileging relatively wealthy Americans over the Panamanians who need them the most.

“The government needs time to deal with this, but it’s hard because there’s corruption, there are a lot of factors,” she says. “I don’t think any of us planned for this. It caught us all off-guard.”

For now, the pace of immigration shows no signs of slowing down—particularly as so many Americans report back on the promising details of their fresh starts.

“We didn’t come down here with a plan at all, but it’s been a great adventure,” says Barbara Rabkin, formerly of Cincinnati. After losing money in the stock-market crash, she and her late husband, Morton, immigrated to Boquete and opened up a successful bakery.

“You don’t know what’s out there, but when things present themselves, you grab them,” Barbara says. “We’ve been pioneers, creating new realities.”