This article examines a context in which immigrants from the former Soviet Union must navigate the English-speaking medical system in a semi-rural area of the USA. In this setting, institutional interpretation resources are not consistently available, and various informal arrangements emerge. One type consists of naive interpreters such as family members of low bilingual capability and/or medical knowledge. Another arrangement involves relatively skilled bilinguals who have command of medical terminology but who are not professionally trained as interpreters. Three case studies of this latter category of 'lay interpreters' are presented. Among the roles reported by the lay interpreters are information source and advocate. The three interpreters are making a contribution in the absence of institutionally provided professional resources, and their help can be viewed as better than the use of naive interpreters such as patients' children. However, the lay interpreters also occasionally seemed to stray into ethically grey areas. For instance, one interpreter said he discarded a client's outdated medicine against her wishes, and another expressed envy of ungrateful clients who had better healthcare access than she did. While professionally trained interpreters are not immune from ethical challenges, such training would better safeguard both patient and interpreter.