Mangroves on Pacific high islands offer a number of important ecosystem services to both natural ecological communities and human societies. High islands are subjected to constant erosion over geologic time, which establishes an important source of terrigeneous sediment for nearby marine communities. Many of these sediments are deposited in mangrove forests and offer mangroves a potentially important means for adjusting surface elevation with rising sea level. In this study, we investigated sedimentation and elevation dynamics of mangrove forests in three hydrogeomorphic settings on the islands of Kosrae and Pohnpei, Federated States of Micronesia (FSM). Surface accretion rates ranged from 2.9 to 20.8 mm y⁻¹, and are high for naturally occurring mangroves. Although mangrove forests in Micronesian high islands appear to have a strong capacity to offset elevation losses by way of sedimentation, elevation change over 6½ years ranged from −3.2 to 4.1 mm y⁻¹, depending on the location. Mangrove surface elevation change also varied by hydrogeomorphic setting and river, and suggested differential, and not uniformly bleak, susceptibilities among Pacific high island mangroves to sea-level rise. Fringe, riverine, and interior settings registered elevation changes of −1.30, 0.46, and 1.56 mm y⁻¹, respectively, with the greatest elevation deficit (−3.2 mm y⁻¹) from a fringe zone on Pohnpei and the highest rate of elevation gain (4.1 mm y⁻¹) from an interior zone on Kosrae. Relative to sea-level rise estimates for FSM (0.8–1.8 mm y⁻¹) and assuming a consistent linear trend in these estimates, soil elevations in mangroves on Kosrae and Pohnpei are experiencing between an annual deficit of 4.95 mm and an annual surplus of 3.28 mm. Although natural disturbances are important in mediating elevation gain in some situations, constant allochthonous sediment deposition probably matters most on these Pacific high islands, and is especially helpful in certain hydrogeomorphic zones. Fringe mangrove forests are most susceptible to sea-level rise, such that protection of these outer zones from anthropogenic disturbances (for example, harvesting) may slow the rate at which these zones convert to open water.