China is the single most important factor for the future of North Korea. The North’s deteriorating economy, ailing leader, and seemingly unstable political transition all could contribute to North Korea’s dependence on external sources,especially political and economic support from China. In considering the importance of China’s North Korea policy and its implications for regional security, this article narrows its focus to China’s policy toward North Korean defectors, the possibility of change in that policy, and the regional security ramifications of the policy. By highlighting the Chinese dilemma concerning North Korean escapees, that is, a decision between interests and responsibility, this article argues that, despite China’s traditional policy stance on North Korea—summarized as its political and economic support for the DPRK regime for the sake of regional peace and stability—refugee problems between the two countries could be an issue of great concern and conflict due to the meaningful efforts of concerned states and the international community.