Research on competitive manufacturing (CM) in high-cost environments has earlier indicated that firms struggle to remain competitive and that manufacturing operations often have been offshored to low-cost environments. The purpose of this research is to explore and create a compounded view of challenges related to both internal and external environments of firms when operating in high-cost environments. This issue has been investigated through a qualitative case study involving five manufacturing firms in Sweden. This research has empirically derived the challenges associated with sustaining CM in high-cost environments and developed a prescriptive checklist. Seven main categories of challenges have been identified, ranging from a micro level related to product characteristics and employee involvement, to a macro level related to supply chain collaborations and industry systems. This research contributes to the existing literature on CM in high-cost locations by explaining and detailing what constitutes challenges in this kind of environment.