All the exam materials (randomly generated multiple choice exams) are generated online (we have to download and print), and once scored, we have a program to enter the pass/fail information to submit the results electronically to the FCC.
We have held ham exams in Palau, several times in the Philippines, and New Zealand.
We started talking to one guy who was asking about communications when sailing offshore. This guy was on a really tight budget, so we told him about doing email using HF Radio via Winlink. The equipment to do this is about the same cost as an Iridium Go, but once you are set up, you can sent and receive email, and download weather for FREE. Besides the equipment, the only requirement is a valid ham license.
So one thing led to another, and we organized a ham exam session. We needed 3 "Extra" class ham licensees, and as luck would have it, another cruiser in the bay had the credentials to become our 3rd examiner. This worked well on the first session, but on the 2nd session, our 3rd guy had moved on. We miraculously were able to hook up with a Filipino in Cebu who was also an Extra Class US licensee, so he was our 3rd guy on the 2nd session.
Two of the examinees were able to test their way all the way to Extra Class!