International students in institutions of higher education in English-speaking countries make valuable educational and economic contributions. For these benefits to continue, universities must become more knowledgeable about the adjustment issues these students face and implement appropriate support services. This review identifies factors that influence the adjustment and academic achievement of international students. Adjustment challenges are primarily attributable to English language proficiency and culture. Achievement is affected by English proficiency, academic skills and educational background. Understanding international student adjustment issues has global implications for intercultural education. Successful support interventions are reviewed and implications for practice discussed.