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In the United States, federal and state governments have taken steps to ban gender-affirming care for trans youth and criminalize parents and medical providers. In response, some US families with trans children are relocating internationally to countries as widespread as Uruguay, Thailand, and Spain. This qualitative study examines the high stakes of international relocation for trans children who are fleeing anti-trans US policies. Drawing on interviews with 15 parents of transgender children, the findings illuminate the sacrifices involved in international relocation. Far from a simple cost-benefit analysis, international relocation decision-making is characterized by risk and uncertainty as families consider a wide range of variables including health, safety, educational needs, and the well-being of the entire family.