Foreign-born providers make up over a quarter of the physician workforce nationally. Patients in south central Pennsylvania are primarily white with limited interaction with foreigners which can produce barriers to communication and trust. This study proposes practical steps for building positive relationships between patients and their foreign-born providers. Ethnographic methods were used to interview and survey patients and providers about the relationships between foreign-born providers and patients, primarily in the Summit Health system. The results of the study provide a framework of how trust is built between patients and providers in general, suggest additional actions for foreign-born providers, and propose ways patients can do their part to achieve a positive relationship with their provider. While much of the literature on cultural competence is in the context of patients who are from minority ethnicities, this study adds to the body of research by also considering the providers as part of minority groups.