An increasing number of universities in Japan, as well as in East Asia, have been introducing English-medium instruction (EMI) programs and courses in recent years. This chapter reviews the medium of instruction policies in the higher education, focusing on cases from Japan. For example, series of the governmental-level policies, such as G30 (2009) and the Top Global University Project (2014), have accelerated the introduction of EMI programs throughout Japan and had a large influence on the sociolinguistic habitat. However, program participants, as well as policymakers and the general public, have not critically examined the “E” of EMI. EMI is still a paradoxical space for the local and foreign participants whose native language is not English, and who need to balance the imposed Anglo linguacultural norms and the local values and practices. It is also pointed out that Japanese business sectors, unless the job is so specialized, require a high level of Japanese proficiency for university graduates, regardless of their language backgrounds, to work with Japanese colleagues and clients in Japan. To develop sustainable EMI programs in Asia, the diverse linguistic and cultural resources that the participants bring in need to be fully recognized and mobilized.