When the Trump administration unveiled its plan last month to attach a $100,000 fee to every new H-1B visa, the move was largely framed as a way to rein in tech giants’ dependence on foreign talent and push them to prioritize American workers. But the ripple effects are being felt far beyond Silicon Valley. Across America’s rural heartland, hospitals and community clinics are warning that the policy could deepen an already critical healthcare crisis like cutting off access to foreign-trained doctors, nurses, and specialists who have long filled essential gaps in underserved regions.
For small-town hospitals that depend on immigrant physicians to keep emergency rooms open and provide specialized care, the steep fee could make sponsorship financially unviable. Many of these institutions, already struggling with tight budgets and staffing shortages, say they simply cannot afford to compete with large urban healthcare systems or tech corporations in paying six-figure visa costs. As a result, communities that already lack adequate healthcare infrastructure may find themselves facing longer wait times, reduced services, and worsening health outcomes.
“There’s no way we’re going to pay $100,000,” said Carolynn Lundry, a residency program coordinator at St. Luke’s Hospital in the St. Louis suburb of Chesterfield, Missouri, as quoted by CNN Business.
Lundry, who oversees residency programs at St. Luke’s and brings on about 16 internal medicine residents each year, warned that the new visa restrictions could make an already difficult recruitment process even harder. “We pool from international graduates, and if we’re going to take away the H-1Bs from that, it’s going to shrink our pool of choices,” said Lundry.
READ: Silicon Valley stays silent: Why the biggest beneficiaries of H-1B visas aren’t speaking up? (
The concern isn’t unfounded. A 2021 study published by the National Institutes of Health (NIH) found that more than 64% of international medical graduates were serving in medically underserved or health professional shortage areas, with nearly half working in rural communities. These doctors often form the backbone of care in places where hospitals struggle to attract U.S.-trained physicians.
With the new H-1B fee threatening to limit their entry, experts fear that the country’s most vulnerable regions could face an even deeper crisis, one where access to basic healthcare becomes a luxury rather than a guarantee.
According to a 2024 report by the Health Resources and Services Administration (HRSA), the United States is already short by more than 13,000 physicians needed to meet existing demand. The outlook grows even more concerning as the HRSA projects that by 2037, the nation could face a deficit of over 87,000 full-time primary care doctors. Such a shortfall would place additional strain on rural hospitals and clinics, many of which are already operating with minimal staff and limited resources.
In response to growing alarm within the medical community, the American Medical Association, along with more than 50 healthcare organizations, has called on the Trump administration to exempt international medical graduates from the steep visa fee.
“States with a higher percentage of H-1B physicians are often those with lower physician density,” they wrote in a letter to Kristi Noem, the secretary of the Department of Homeland Security. “The U.S. health care workforce relies upon physicians from other countries to provide high-quality and accessible patient care.”
For small rural hospitals like St. Luke’s, the combination of physician shortages and the new visa fee poses a serious threat to their ability to maintain adequate staffing. The hospital already struggles to attract U.S.-trained graduates, in part because it isn’t affiliated with a major academic program, a factor that often draws American residents seeking competitive placements after their training.
“We need so many physicians in this country, and there just aren’t enough American medical graduates to fill all of those positions. We have to draw from other places,” Lundry said.
READ: Meet the lawyers challenging Trump’s $100,000 H-1B fee in Global Nurse Force v. Trump (
According to Lundry, international applicants bring valuable experience and exceptional academic performance to the table. Their inclusion allows her to select candidates who have prior clinical exposure and, in many cases, achieve what she describes as “astronomical” scores on U.S. qualifying exams.
“Those people can be stellar stars,” she said, emphasizing how their expertise often elevates the overall quality of residency programs like St. Luke’s.
While hospitals like St. Luke’s grapple with physician shortages, clinics are facing similar uncertainty. Dr. Chuck Thigpen, chief clinical and strategy officer at ATI Physical Therapy, said he is unsure whether the he will be able to honor the job offers extended to international graduates set to begin work in January.
ATI currently has 450 open clinical positions nationwide, along with 49 employees on H-1B visas and 97 on H-4 visas issued to the spouses and dependents of H-1B holders. With the new policy in place, Thigpen fears that filling critical roles and retaining skilled professionals may soon become an uphill battle for healthcare providers everywhere.
“There are way more jobs than we have even applicants applying for those jobs, so there’s not enough qualified therapists with licensure to fill our current workforce needs,” Thigpen said.
“We’re already under severe pressure of just margin to keep clinics open and be sustainable,” he added. “So, if I now layer on an additional $100,000 per hire to bring in, I can’t do it. I just have to close clinics.”