But Clinton's visit turns this year's forum into a rare opportunity for Pacific leaders to get the ear of one of the most powerful people on earth. It also says something of what America sees in the Pacific.
Stingingly, the Pacific Islands Forum countries were described in American media recently as isolated and "strategically unimportant".
Clinton's visit will help expel that perception.
The United States is still likely to put a lot more emphasis on the "Asia" part when it talks about its renewed focus on the Asia Pacific. In fact, after her day in the Cook Islands, Clinton will be heading to Indonesia and China before going on to Apec in Russia next week.
However, this is the highest powered delegation the US has ever sent to the Pacific Islands Forum, topping last year's delegation of 50 representatives to the forum meeting in Auckland.
It is an admission that the United States has perhaps neglected the Pacific Islands and left a hole for China to fill, and that the United States is now a bit nervous about that.
Apart from helping to build the forum's credibility, Clinton's visit will give momentum to calls for more women to get into positions of political leadership in the Pacific Islands. Australia's Prime Minister Julia Gillard is spearheading this. She will announce a significant funding package to help boost numbers.
It is a long-standing problem.
Most people might not think of NZ First leader Winston Peters when they ponder the modern feminist, but even Mr Peters took the Pacific Islands to task over it back in 2008.
As Minister of Foreign Affairs, he said with his usual diplomatic subtlety that New Zealand was entitled to ask some questions about "why all these useless males are running the show".
He said traditional societies needed to rely on their women more instead of leaving it to men who "spend most of their time parading around the maraes like peacocks and do no work when it matters".
Four years later and it is still predominantly men. Gillard is the only female leader of the 16 forum nations, just as Helen Clark was before her.
The issue is one of the staples on the forum calendar, but previous attempts have been little more than lip service. This year there is the fire-power to back it up, besides Clinton, the head of United Nations Women Michelle Bachelet will be there.
In a recent speech in Australia Bachelet set out some depressing figures - that globally women made up less than 10 per cent of the world's leaders and just one in five members of parliament.
The worst was that the Pacific, with the exception of New Zealand and Australia, had the dubious honour of having the lowest proportion of female parliamentarians of any region at just 3.5 per cent - well below the average 20 per cent - and many parliaments had no women at all.
Just days after making his comments about lazy Pacific Island men, Mr Peters bravely headed off on the Foreign Minister's annual Pacific Trip to confront the peacocks.
Although Peters himself only had one female MP in his own caucus at the time, it was refreshing to see males on the end of a diplomatic drubbing for a change.
It is usually the women who have come a cropper.
An incident last year might make it clear why Gillard is now looking for some company at the leaders' table - the forum leaders have their own version of WAGs and there is only one HAB (husbands and boyfriends) - Gillard's partner.
In Auckland for last year's forum, one official was clearly confused and tried to direct Gillard away from the leaders' bus and into the WAGs' and HABs' bus for transport.
Clinton's visit will also at least give Key another chance to redeem himself after his own mix up in Wellington in 2010 - when he referred to Clinton by her husband's title of "President Clinton".
