Research and development activities have become more and more internationalized with emerging economies playing an increasingly important role. This phenomenon is particularly debated in the pharmaceutical industry where (Western) pharmaceutical companies have started to offshore clinical research to so-called nontraditional clinical research countries. This study empirically investigates the changing geography of clinical research between the years 2002 and 2012. Building on the concept of national innovative capacity (Furman et al., 2002, Res. Policy, 31, 899–933), we shed light on different drivers of countries’ attractiveness as a location for clinical research including arguments related to the supply (cost)-side, the demand-side, and the knowledge base. Our results challenge existing views on the extent of the phenomenon as well as the involvement of particular countries. Across nontraditional countries, the level of clinical research activities is driven by knowledge rather than cost arguments. Moreover, the rising strength of the knowledge base of nontraditional countries enables them to increasingly direct research in favor of local needs.