Transcultural psychiatry is generally thought to be an appropriate concern only in distant or unusual environments. But because many immigrant groups in the U.S. maintain their original customs and traditions, a transcultural approach may be necessary in many clinical situations, as illustrated by the case histories of three immigrant patients on a university hospital's psychiatric service. All had manifestations of severe psychiatric disturbance, but their clinical evaluation and management were complicated by difficulties in communication and by culturally linked behavior patterns and family responses at variance with American norms. Careful attention to transcultural factors is necessary for the optimal management of such cases.