Globally, one in three students are now enrolled in private higher education institutions (PHEIs), with the total reaching almost 70 million enrolments. This pattern is similar across a highly diverse Asia: more than 35% of students are enrolled in the private sector, and around 60% of higher education institutions (usually much smaller than their public counterparts) are private. But in East Asia, a combination of high participation rates and a rapidly ageing demographic has led to a complex, developing crisis, particularly in a much-expanded private sector. Adding to the existing suite of problems -- finance, over-supply, declining standards, regulatory issues, and in some cases, corruption -- the combined effect of recent COVID disruptions, regional economic reversals, and a rapidly ageing demographic has intensified existing problems, constituting a major crisis for the sector, especially more marginal private institutions. The analysis charts the various responses of governments in Japan, South Korea, Taiwan, and China, draws out some of the limits to reform, and poses the dilemma for the future of private higher education in the region.