Taiwan, Mexico, and Costa Rica have been ranked as the top spots to live and work abroad in 2021, based on their cost of living, ease of settling in, and overall quality of life.

The U.S. was ranked only 34th out of 59 places, largely because of how ex-pats viewed the quality of life in America, according to a new survey published Tuesday.

Taiwan topped the charts for the third year in a row in the survey of 12,420 ex-pats conducted by InterNations, a Munich-based ex-pat network with about 4 million members. Expats appreciated Taiwan’s medical care, on top of the quality of life. A full 96% of respondents were happy with the quality of care, compared with 71% globally. Expats also reported they were more satisfied with their job security in Taiwan and the state of the local economy than their peers in other locales.

Expats’ Favorite and Least Favorite Places

InterNations Expat Insider 2021 Survey

Health was, of course, of particular concern for ex-pats this year. InterNations measured the role Covid-19 has played in the lives of ex-pats, but its pandemic-related findings did not influence locations’ overall rankings. Globally, 45% of respondents said the pandemic had some influence on their time abroad or plans to go abroad.