Phase 1 site selection is no longer a simple question of speed or cost. Sponsors must match the geography to the actual study type: healthy-volunteer first-in-human work, patient-based early-phase development, bridging studies, or market-linked development programs. Australia remains the cleanest option for many healthy-volunteer studies, China is compelling when market access is part of the objective, and India is emerging as a credible alternative for patient-based early-phase, bridging work, endemic-disease studies, and select first-in-human programs tied to India-linked development.