Background <p>Internationalization in higher education offers significant benefits for universities and host societies, yet international students frequently encounter multiple adaptation challenges. This study explored the key challenges, potential solutions, opportunities, and future prospects for international students at Iran University of Medical Sciences (IUMS).</p> Methods <p>A qualitative study was conducted in 2024 with 31 international students meeting defined inclusion criteria. Data were collected using semi-structured interviews in Persian or English, transcribed verbatim, and analyzed thematically using MAXQDA 2022. Trustworthiness was ensured through credibility, dependability, confirmability, and transferability criteria.</p> Results <p>Four main categories emerged: (1) challenges — including language barriers, environmental adaptation, academic overload, cultural differences, nationality-based discrimination, personal isolation, and financial constraints; (2) solutions — such as curriculum restructuring, enhanced language courses, cultural awareness programmes, improved faculty English proficiency, and institutional advisory support; (3) opportunities — encompassing high-quality educational resources, diverse institutional support services, and personal skill development; and (4) future prospects — with most students intending to return to their home countries after graduation.</p> Conclusion <p>International students at IUMS face interconnected linguistic, social, educational, cultural, and economic challenges that can adversely impact academic performance and well-being. Practical, multi-level interventions are necessary to support their integration and success. The findings provide actionable recommendations for university administrators and policymakers to improve the recruitment, retention, and satisfaction of international students and to strengthen the internationalization of medical education in Iran.</p>