This piece argues that Nigeria’s ambitious 2024 National Policy on Health Workforce Migration, while well-intentioned, faces a fundamental challenge: a crisis of trust. As Nigeria grapples with severe healthcare worker shortages—just 33 professionals per 10,000 people—the success of new retention initiatives hinges not on their design, but on rebuilding healthcare workers’ faith in government commitments. Drawing from historical policy failures and implementation challenges, this paper contends that without addressing core issues of political trust, competitive compensation, and sustained funding, even the most sophisticated policy framework risks becoming another unfulfilled promise in Nigeria’s healthcare reform journey.