Republican Senator Says Trump’s Steep H-1B Visa Fee Could Hit Rural Hospitals

President Donald Trump’s new $100,000 fee for companies hiring high-skilled foreign workers could make it harder for rural hospitals to find the specialists they desperately need, a Republican senator warned.

“Healthcare systems need clarity for how the administration’s actions will affect them,” Sen. Kevin Cramer, a North Dakota Republican, told NOTUS in a statement Friday.

In rural America, high-skilled foreign workers “are often the only specialists serving communities,” Cramer said.

“Congress and the administration need to focus on merit-based immigration policies to help meet our growing economic needs,” he added.

The new fee raises the price of hiring foreign workers more than tenfold, from a former average of roughly $10,000 in legal and administrative costs for H-1B visas to a one-time payment of $100,000 for new applicants.

Critics of the policy change say increasing the costs of hiring foreign health care professionals could contribute to an existing shortage of doctors in some states.

A White House spokesperson said the change is intended to discourage “companies from spamming the system and driving down American wages.”

“President Trump will continue to prioritize rural health care, as evidenced by his $50 billion rural health care fund and his commitment to making healthcare and pharmaceutical drugs more affordable,” the spokesperson told NOTUS.

Lawmakers from rural areas could press for exemptions from the fee for the health care industry; Cramer co-sponsored legislation prior to the new fee that was intended to make hiring foreign workers more efficient, with hospital staff shortages in mind.

Trump and his allies have focused on the tech sector rather than the health care system when explaining the fee, accusing large tech companies of hiring foreign workers when Americans may be able to do the same jobs.

“American workers are being replaced with lower-paid foreign labor, creating an economic and national security threat to the nation,” the White House claimed when announcing the change.

A New York Times analysis of H-1B applications in 2024 found that a third of the jobs offered salaries equal to or less than the new $100,000 fee, while the rest offered salaries above that amount.

Tech companies are facing bipartisan scrutiny for foreign hires amid layoffs of American workers. A group of senators earlier this week pressed tech companies for details on wages for foreign high-skilled workers and whether they are prioritizing protecting American jobs.

“With all of the homegrown American talent relegated to the sidelines, we find it hard to believe that Amazon cannot find qualified American tech workers to fill these positions,” Sens. Chuck Grassley and Dick Durbin wrote in a letter to Amazon, according to The Wall Street Journal.

Grassley also tweeted about unemployment among STEM graduates: “Maybe its bc Big Tech is laying off US workers while requesting tens of thousands of H1B visas.”

For more than 30 years, the H-1B system has allowed companies to hire foreign workers, most of whom have come from India and China.

China hawks in Congress have praised it as one avenue to boost America’s competitiveness during a tech race with Beijing, drawing talent from around the world away from other countries.

“Beijing is cheering,” Rep. Raja Krishnamoorthi, the top Democrat on the House select committee on competition with the Chinese government, told NOTUS in a statement this week about Trump’s new fee on hiring.

The change “makes it harder for America to attract top innovators while helping China close the gap,” Krishnamoorthi said. “Our edge has always come from developing American talent and welcoming the best from around the world.”