International graduate students meet TOEFL, GPA, and other admissions criteria to gain entry into US colleges and universities. During their stay in the USA, they provide educational and economic contributions for their host country. In contrast to their educational and economic potential, international students often demonstrate poor academic and social integration at their host institutions. Grounded theory methodology was used to investigate what accounts for the academic, cultural, and social adjustment problems faced by East Asian graduate students pursuing studies at an elite private not-for-profit university in the USA. Findings reveal that students experienced lowered self-confidence and acculturative stress as a result of challenges encountered during their first year, language barriers, different teaching styles and teaching environments, and their interactions with professors. Raising faculty sensitivity to cultural differences among international students, early adjustment counseling and obtaining regular feedback are recommended.