Hello from the beautiful Black Hills of South Dakota. I'm Arielle Zionts, a rural health care correspondent based in Rapid City. Send me tips at azionts@kff.org.
By Arielle Zionts
More than 30 people have applied for a lab technician job at West River Health Services in Hettinger, North Dakota, a thousand-person town in the rural southwestern part of the state.
Because they aren't U.S. citizens, they would each need a visa.
West River and other companies used to pay up to $5,000 in fees to sponsor each H-1B visa for such workers.
The nonprofit hospital now has to pay $100,000 if it wants to hire one of the new applicants, who are all from the Philippines or Nigeria. Or it could spend money on an attorney to petition the government for an exemption from the new fee.
H-1B visas are for highly skilled foreign workers in fields — such as the chronically understaffed rural health system — that struggle to find enough American employees.
In September, President Donald Trump increased the visa fee to $100,000 for workers living outside the U.S. It doesn't apply to foreign workers or students who were already in the U.S. on a visa.
His proclamation rails against the tech world's use of H-1B workers, but the new fee applies to all fields.
"The health care industry wasn't even considered. They're going to be collateral damage, and to such an extreme degree that it was clearly not thought about at all," said Eram Alam, a Harvard associate professor whose new book examines the history of foreign doctors in the U.S.
Federal guidance says H-1B applicants will receive a fee exemption only in an "extraordinarily rare circumstance."
The American Hospital Association, two national rural health organizations, and more than 50 medical societies asked Homeland Security Secretary Kristi Noem to grant categorical exemptions for the health care industry. The new cost will disproportionally harm rural communities that already struggle to afford and recruit enough providers, the groups argued.
DHS officials directed inquiries to the White House, which did not answer questions about individual waiver timelines or the possibility of an exemption for the health care industry.
Instead, White House spokesperson Taylor Rogers sent a statement defending the new fee, saying it will "put American workers first."
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