As China's higher education system underwent dramatic growth and development in the 1990s and early 2000s, there was a proliferation of educational collaborations between Chinese and foreign universities. Many US universities saw positive benefits to building educational programs and exchanges with Chinese universities, such as enhancing institutional prestige, creating academic and research opportunities, generating revenue, and growing international student enrollments. However, these programs often struggle to produce positive outcomes and meet university expectations and there has been a lack of research into the critical factors for the long-term success and sustainability of these programs. This study explores the internationalization and development of Chinese higher education, US higher education institutions establishing operations in China, and how these programs navigate changes and challenges. This qualitative, multi-site case study seeks to answer the following questions: How do program administrators describe the motivations and critical factors (and their work) behind the establishment of US-Chinese university collaborations between 1980 and the present??How were these US-Chinese university collaborations structured originally, and have these structures shifted over time? How do administrators, faculty, and students describe the challenges they face in these programs? How is COVID-19 impacting their work, their perspectives and their motivations? Through the use of semi-structured interviews and artifact analysis, this study seeks to explore how these programs were established, how they are managed, and how they are dealing with difficult challenges and shifting terrain. The purpose of this study is to help universities to build more effective and sustainable programs moving forward, and better educate a new generation of students that has a deeper understanding of the complex issues in the US-China relationship. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]