This article investigates the wage effects of employment in care work – conceptualized as work providing face-to-face client services that strengthen the health, skills or safety of recipients – in 12 countries representing a range of economic and policy contexts. While previous research has found an earnings penalty for care work, this article finds remarkable cross-national variation in that effect. The authors find that worker characteristics and job characteristics shape the effect of care employment on earnings. They also consider how country-level factors – earnings inequality, size of public sector, and trade union strength – impact upon cross-national variation in the effect of care employment on earnings.