In the second half of the nineteenth century, millions of Muslims migrated from former Ottoman lands, fleeing an encroaching Russian Empire in the North Caucasus and Crimea and nationalist struggles in the Balkans. Various waves of this movement have been labeled a humanitarian disaster by both contemporary observers and historians, who note the toll of epidemic diseases within makeshift refugee camps and describe mortality rates exceeding several hundred migrants per day in the empire’s port cities. Despite this recognition of the importance of disease during migrant arrival, health and sickness remain understudied components in historiographies of both the migrants’ eventual integration into Ottoman society and in assessing the efforts of state actors to settle newcomers. Drawing upon underutilized sources from the Ottoman Prime Minister’s Archive, this paper will address these omissions through emphasizing the importance of environmental and health factors on migrant mobility and settlement beyond quarantine and refugee zones. Scholars emphasize multiple reasons the financially strapped empire accepted scores of impoverished newcomers. Aside from creating a loyal Muslim “buffer zone” and maintaining legitimacy as the Islamic caliphate, goals included the economic boon of a widened tax base and increased tillage of arable land. While humanitarian concerns remained a significant motivation in addressing migrant illness, state actors also recognized the success of these endeavors was dependent upon fostering a healthy, productive population. Thus, state generated sources discuss the need to move newly settled migrants struggling in environmentally difficult locations to more salubrious locales. Migrant petitions, often stored in the records of the Muhacirin Komisyonu (Emigrant Commission), reveal that migrants likewise engaged in evaluating the relative healthfulness and quality of land to request small- and large-scale transfers. Focusing on environmental and health concerns allows for greater exploration of refugee mobility within the empire, offers insight into long-term processes of settlement and integration, and highlights a point of dialogue between the state and migrants revealed by migrants’ own environmental evaluations.