This is a very good question because there are so many assumptions you make before moving to China, especially if you have not visited before.

In my case of living in Shanghai, I was surprised to see how developed and modern the city really is. Despite challenges in language, living in Shanghai is very manageable.

It does take time to grow accustomed to the size and complexity the city first seems. During high traffic hours, the sidewalks are crowded full of Chinese commuters, the metro is crowded and the cars are stuffed to the brim, and the car traffic is bumper to bumper is an a completely disorganized chorus of light violations and honking.

Other sources of instant culture shock include the prevalent practice of spitting, clearing the throat, and line-cutting or an outright inability to acknowledge that a line has been formed. Another big change from certain parts of the Western world is smoking. Smoking is very commonplace and non-smoking sections are never seriously enforced. These are definitely sure to impact most expats on some level, but you do get used to them.

The difficulty in language also poses some problems for expats. It is difficult to lease an apartment, handle maid or "ayi" instructions, dry clean clothes, or handle other every day tasks that you never thought twice about in your native country. These circumstances definitely require patience and the understanding that you are in a foreign country, and do not speak their language. In almost all cases, you figure out ways to get around language issues through practice and help for seasoned expats.

But for the most part, expats living in China live in a standard that is very close to, at, or exceeds the standard in their home country. Living in China affords other great luxuries that often balance out the negative. Your experience in most large cities can be what you wish. Expats can certainly find ways around language issues or barricade themselves from the Chinese culture shock issues listed above by finding companies, apartments, restaurants and service providers catering to expats. However, this does tend to be considerably more expensive. Personal concierge assistants, private drivers, service apartments and other luxuries will certainly help alleviate the level of culture shock you experience.