Transnational couples make life together while far apart across international borders. Fully understanding transnational couple living requires an in-depth analysis of the causes of marital relationship strains among transnational couples and the behavioral adjustments and expectancies needed to accommodate relationship disruptions. Framed within the double ABC-X model of family stress and coping, this study investigated the impacts of transnational living on married Ghanaian couples. Twenty-Four married participants from three U.S. States and their Ghanaian spouses in Ghana were interviewed. Participants shared what motivated their transnational migration to the United States, how U.S. immigration policies influenced their marriage, and the psychological, physical, and emotional impacts of transnational living on them and their marriage relationship. Findings reveal that married transnational couples experience relationship strains that significantly affect different domains of their health and wellbeing. These strains exhibit as psychological, physical, and emotional challenges. Participants reported issues including recurring depression, chronic illnesses, financial hardships, and divorce. These relationship strains were found to result from unrealistic expectations about life in the U.S., inadequate understanding of immigration realities, lack of relationship nurturing, and barriers created by changing U.S. immigration policies. This study has implications for health practitioners and immigration policymakers.