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The demand for global health educational opportunities among students and trainees in high-income countries (HICs) has led to a proliferation of available global health programs. In keeping with the drive towards competency-based medical education, many of these programs have been defining their own global health competencies. Developing such competencies presents several unique challenges, including (1) a failure to take sufficient account of local contexts coupled with a lack of inclusiveness in developing these competencies, (2) the disjunction between the learning approaches of “individualism” in HICs and the relative “collectivism” of most host countries, and (3) shortcomings associated with assessing competencies in resource-limited settings. To meet these challenges, the author recommends reenvisioning the approach to competencies in global health using fresh metaphors, innovative modes of assessment, and the creation of more appropriate competency domains.