For the first time in its history, South Korea is experiencing the challenge of extremely low fertility and a rapidly increasing number of elderly persons. This dramatic shift in population distribution is a result of total fertility rates below replacement levels for the past thirty years and to a smaller extent, increases in life expectancy. To date, policies have not been effective in increasing fertility levels; social and economic structures currently in place have encouraged delayed marriage and delayed childbearing. For any pronatalist policy to be effective there will need to be major changes, so that women can better integrate working and familial roles. It will become critical for South Korea to adjust to smaller families to care for the elderly and to have a greater reliance on the government for pensions and support of the elderly. The income redistribution will come at a time when the numbers of persons in the labor force will be contracting as a result of sustained low fertility. If government actions are not effective to increase fertility, then it will take the collective efforts of civil society to make the necessary adjustments to the new population distribution.