In the age of globalization and massive mobility, local and dynamic understandings of im/migration, health, health policy and health care are increasingly important. In recent literature, Sarah Willen and colleagues (2012) introduce the concept of health-related deservingness, bringing to the fore local, everyday “reckonings” of who deserves what and why, as opposed to the well-studied entitlement and access dimensions of health and health care. Inspired by this work and by my own experience as an im/migrant in Canada, this study explores the health-related deservingness “reckonings” of im/migrants in the Algoma region of Ontario, particularly Sault Ste. Marie. Through my analysis of various in-depth interviews and a focus group, I propose that experiences (as opposed to conceptions) of deservingness can be at least as important a determinant of im/migrants’ overall health and well-being as formal entitlement and access. Furthermore, because experiences of deservingness are individual/localized, implicit and dynamic, they are more vulnerable to contextual influences and also more ‘negotiable’. This ‘malleability’ of deservingness presents opportunities to re-think im/migrants’ agency, as well as the moral obligations and responsibilities of im/migrants and non-im/migrants alike.