In the heart of rural Kentucky, Dr. Manikya Kuriti’s days are defined by long drives and longer hours. Patients travel up to two hours to see her, an endocrinologist serving communities where doctors are few and far between. Her husband, Dr. Vinay Nidadavolu, a pulmonologist, splits his time between small hospitals in Indiana and Kentucky, filling crucial gaps in local healthcare teams. Their journeys are emblematic of a nationwide crisis: rural America’s chronic doctor shortage, a problem that’s only grown more acute in recent years.
For decades, immigrant physicians like Kuriti and Nidadavolu—who both came to the U.S. on H-1B visas—have been the backbone of medical care in underserved areas. But a new policy announced by President Donald Trump on October 16, 2025, is sending shockwaves through the healthcare community. The administration’s decision to impose a $100,000 fee on new H-1B visa applications has ignited fierce debate, legal challenges, and warnings of dire consequences for American healthcare.
According to Stateline, the announcement quickly drew criticism from leading medical organizations. The American Medical Association (AMA), joined by more than 50 other groups, sent a letter to the Department of Homeland Security urging an exemption for international medical graduates. Their argument is stark: immigrant physicians make up nearly a quarter of all licensed doctors in the U.S., and almost half of them practice in rural areas—places already struggling with higher rates of chronic illness and early death compared with urban communities.
“A significant fee for any further H-1B visas in the area of the healthcare workforce will be detrimental … especially in low-served areas or rural areas,” said Dr. Tom Price, former Secretary of Health and Human Services under Trump, in an interview with Stateline. His concern is echoed by hospital administrators and physicians across the country. Dr. Sridevi Alla, a hospitalist in Jackson, Mississippi, warned, “In a state which already has a physician shortage, I think that’s definitely going to affect primary care.”
The numbers underscore the urgency. The Association of American Medical Colleges projects a shortage of up to 86,000 doctors by 2036. Between 2001 and 2024, nearly 23,000 H-1B physicians served in communities considered underserved, according to AMA data. The University of Washington, one of many institutions reliant on international talent, has paused H-1B visa petitions altogether. Dr. Tim Dellit, CEO of UW Medicine, lamented in an email to Stateline, “The uncertainty around visas creates a significant disruption for talented individuals who hope to train and work at UW Medicine. It represents a loss for the research and education communities, as well as for the vital clinical care we provide.”
The new visa fee has not gone unchallenged. Earlier this month, labor unions and advocacy groups—including the South Asian American Justice Collaborative and the AFL-CIO Committee of Interns and Residents—filed a lawsuit in the U.S. District Court for the Northern District of California. Their complaint: the administration overstepped its authority, bypassing Congress’s exclusive power to set fees and imposing an unlawful burden on employers and workers alike.
They’re not alone. On October 16, 2025, the conservative-leaning U.S. Chamber of Commerce filed its own lawsuit against the Departments of Homeland Security and State. Neil Bradley, the Chamber’s executive vice president, didn’t mince words: “The new $100,000 visa fee will make it cost-prohibitive for U.S. employers, especially start-ups and small and midsize businesses, to utilize the H-1B program, which was created by Congress expressly to ensure that American businesses of all sizes can access the global talent they need to grow their operations here in the U.S.”
The Chamber’s filing argues that the H-1B program is vital for American innovation, job creation, and economic growth. “These workers allow businesses of all sizes, in industries across the economy, to innovate and grow,” the Chamber stated. “The resulting innovations lead to more American jobs, higher wages, and new products and services that improve the quality of life for all Americans.” Their lawsuit contends that President Trump lacks the legal authority to impose such a fee, since fee setting is the prerogative of Congress, not the executive branch.
While the Departments of Homeland Security and State have remained mostly silent, White House spokesperson Taylor Rogers defended the administration’s move in a statement to Newsweek: “President Trump promised to put American workers first, and his commonsense action on H-1B visas does just that by discouraging companies from spamming the system and driving down American wages, while providing certainty to employers who need to bring the best talent from overseas.”
Some lawmakers have seized on the controversy to push for broader reforms. Senator Dick Durbin, an Illinois Democrat, argued, “Major companies are laying off thousands of American workers while filing thousands of visa petitions for foreign workers at depressed wages and poor working conditions. Congress must step in to protect American workers and fix our broken immigration system.”
The debate is not just about numbers or legal technicalities. For doctors like Kuriti, Alla, and Dr. Mette Strand in Montana—who herself emigrated from Norway—the issue is deeply personal. “Cutting IMGs [international medical graduates], we would be in further need of doctors in an already underserved state,” Strand told Stateline. “I would have a hard time seeing how we would run our hospitals and our clinics.”
The policy’s impact extends beyond healthcare. The Chamber of Commerce, while praising Trump’s efforts to secure the U.S.-Mexico border, warned that high fees on legal immigration could stifle economic growth. The Federal Reserve and Department of Labor have also voiced concerns about the ripple effects of immigration enforcement, with farms and tech companies feeling the pinch as well.
Adding to the uncertainty, the administration has proposed a four-year limit on the stay of J-1 visa holders, another group of international medical graduates who often serve in rural and underserved communities before transitioning to H-1B status. Hospitals now face a daunting new reality. “We still have 30 to 35 international medical graduates that come in,” said Dr. Bobby Mukkamala, president of the AMA, recalling his own parents’ journey to the U.S. for medical training. “Now, hospitals have to figure out where we’re going to get $100,000 per doctor.”
For now, the fee has not been fully enacted; many attorneys report that they have been unable to pay it when submitting new applications. But the chilling effect is already tangible. Immigration lawyer Elizabeth Ricci noted that some hospitals are unsure whether they must shoulder the cost or can pass it on to physicians. “It’s probably going to require litigation to get that guidance,” Ricci said. “And in the meantime, people aren’t filing because they are concerned that they’re going to be responsible for $100,000.”
As the legal battles play out, the stakes remain high for patients, hospitals, and communities across the country. In places like rural Kentucky and Mississippi, the question is not just about policy—but about whether the next generation of doctors will be there when they’re needed most.
