How Rural America Benefits From the H-1B Program

Since its creation in 1990, the U.S. H-1B visa program has enabled American employers to hire highly-skilled foreign workers when native-born talent is in short supply. While tech companies account for the lion’s share of the visas granted each year, H-1B workers fill key needs in other industries as well.

One such field is health care, where foreign workers have been especially crucial for providing care in rural and underserved areas where recruiting American doctors, dentists and other health professionals can be tough.

As many as 1 in 4 physicians are foreign-trained. And according to the American Immigration Council, they are much more likely than their American counterparts to serve in areas with higher poverty and lower educational levels. For instance, says the Council, foreign doctors account for about 43 percent of the physicians practicing in areas with per capita income of $15,000 or less.

Many of these doctors begin their practice in the United States through the H-1B program, which can later become the gateway to a green card and, eventually, to citizenship. In 2016, according to an analysis published by the Journal of the American Medical Association (JAMA), more than 2,100 hospitals and other providers were approved to fill roughly 10,500 physician slots with H-1B workers.

Among the states with the highest share of H-1B applicants were North Dakota – where 4.7% of doctors are H-1B applicants –along with Michigan, Illinois, New York and Ohio, as well as Nebraska, West Virginia, Iowa and Maine. Courtney Koebele, executive director of the North Dakota Medical Association, told The New York Times that these doctors “are vitally important to our state.”

Of particular importance to rural areas is the so-called “Conrad 30 Waiver Program,” named after former North Dakota Sen. Kent Conrad, which waives a requirement that doctors finishing their medical training in the United States return home for two years before they can apply to work in America. Under this program, each state’s health department can petition for H-1B status for up to 30 foreign doctors a year, provided the physicians agree to work in medical shortage area for three years. Since 1994, the program has helped bring more than 15,000 doctors to underserved communities, according to the American Medical Association.


Another need foreign professionals fill is in dentistry, where shortages can be even more acute. For instance, the national dental chain Kool Smiles, which specializes in operating clinics in low-income and rural areas, says that roughly 10 percent of its 500 dentists are in “some sort of immigration status,” according to company official Dave King, including H-1B as well as in the process for other visas or a green card.

Among these dentists is Venezuelan native Orlando Abreu Fuerte, who works in two clinics in rural Virginia. Abreu said he sees 400 to 500 patients a month, some of whom drive from two hours away. “No one wants this job in a rural area,” said Abreu. Moreover, “other dentists are not interested in Medicaid patients,” he said. “I have patients who are three years old with cavities and abscesses and infections.”

While doctors and dentists like Abreu help fill a vital need, there are still not enough of them to meet the demand for skilled professionals. Since 2005, the H-1B program has been capped at 65,000 visas, plus an additional 20,000 for foreign students pursuing advanced degrees. Last year, USCIS reached its 2018 cap on April 7, 2017, just four days after it began accepting H-1B petitions on April 3. All told, the agency fielded a total of roughly 199,000 applications.

Shortly after the 2016 election, newly-elected President Donald Trump ordered a top-to-bottom review of the H-1B program as part of his “Buy American, Hire American” executive order. Since then, the Department of Homeland Security has been considering regulatory changes to restrict the program and make it harder for U.S. companies to apply for H-1B workers.

While the intent of these potential restrictions is to protect American workers’ access to job opportunities, the needs of other Americans – particularly in rural and low-income areas – might end up going unmet.

Further reading:

“Key Facts About the U.S. H-1B Visa Program,” Pew Research Center, April 27, 2017.

“Nonimmigrant (Temporary) Admissions to the United States: Policy and Trends,” Congressional Research Service, Dec. 8, 2017.

H-1B Program Overview and Fact Sheets, U.S. Department of Labor.