From hospitals to medical deserts: Why Trump’s H-1B visa fee risks leaving millions of Americans without healthcare

A sharp hike in H-1B visa fees under President Donald Trump threatens to remove one of the few remaining lifelines rural hospitals have to survive. (File image used for representation)

Rural US hospitals face closures due to financial strain and staff shortages. Trump's $100,000 H-1B visa fee hike threatens access to foreign healthcare workers, risking more medical deserts and worsening care for millions in vulnerable communities.

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Rural America is facing a healthcare emergency that is quietly deepening. Across the United States, hospitals in small towns and remote regions are shutting down or cutting back essential services, leaving large swathes of the country without reliable access to doctors, emergency care or specialised treatment. The crisis is driven by two forces working together: chronic staffing shortages and mounting financial stress. Now, a sharp hike in H-1B visa fees under President Donald Trump threatens to remove one of the few remaining lifelines rural hospitals have to survive.

Rural hospitals are disappearing

The scale of the problem is already alarming. Since 2005, at least 195 rural hospitals across the US have either closed entirely or been converted into facilities offering only outpatient and emergency care, according to the Cecil G Sheps Centre for Health Services Research at the University of North Carolina. Several more shut their doors or drastically reduced services in 2025 alone.

The outlook is even bleaker. The Centre for Healthcare Quality and Payment Reform estimates that more than 700 rural hospitals, roughly one in three nationwide, are at risk of closure due to severe financial stress. Over 300 of them are considered to be in immediate danger.

Many hospitals that remain open have stopped offering critical services. Between 2011 and 2023, nearly 300 rural hospitals discontinued obstetrics care and more than 400 stopped providing chemotherapy, according to healthcare consultancy Chartis. These are not optional services. For rural residents, losing them often means travelling hours for basic treatment.

Why rural hospitals are struggling

Rural hospitals operate under structural disadvantages. Patient volumes are lower, but fixed costs remain high. Reimbursements from private insurers and Medicare Advantage plans are often inadequate, pushing many hospitals into negative margins year after year.

Recent policy changes have worsened the situation. Reduced Medicaid funding following the Trump administration’s 2025 One Big Beautiful Bill Act has further strained hospital finances. A report by the Boston School of Public Health warned that these cuts could strip more than 17 million Americans of health insurance by 2034, discouraging people from seeking care and reducing hospital revenue even further.

Staffing shortages compound the financial pressure. More than 60 percent of rural areas are officially designated as Health Professional Shortage Areas by the Health Resources and Services Administration. Lower salaries, geographic isolation and limited career opportunities make it difficult to attract doctors, nurses and technicians to rural postings.

Mercer, a US consultancy, projects a nationwide shortfall of 3.2 million healthcare workers by 2026, including tens of thousands of nursing assistants. Rural hospitals feel this shortage most acutely.

H-1B visas became a critical lifeline

In recent years, rural hospitals found a partial solution by turning to foreign-trained healthcare professionals on H-1B visas. These visas allowed hospitals to recruit doctors, nurses, lab technicians and therapists who were willing to work where domestic candidates often would not.

“This talent is otherwise not available to come to rural parts of the country,” said Brian Thomas, CEO of Jefferson Regional Medical Centre, in comments to Arkansas Business.

The numbers underline the importance of the programme. A study published in the Journal of the American Medical Association found that in 2024, nearly 11,100 physicians were working in the US on H-1B visas. While they made up less than one percent of the overall physician workforce, their presence was far more significant in rural areas.

In rural counties, about 1.6 percent of physicians were on H-1B visas, nearly double the share in urban areas. Between 2016 and 2022, around 11 percent of all physician H-1B applications were specifically for rural practice. Immigrants also make up 16 percent of registered nurses and 14 percent of physician assistants and nurse practitioners nationwide.

For many rural hospitals, these professionals are not a supplement. They are the system.

The impact of Trump’s H-1B fee hike

That fragile system is now under threat. President Trump’s decision to raise the fee for new H-1B visas to $100,000 places an enormous financial burden on rural hospitals already struggling to stay afloat.

“We’re all struggling to get by, so paying $100,000 to acquire one of any kind of professional would pose an impossibility,” said Glenda Harper, CEO of Ouachita County Medical Centre, also speaking to Arkansas Business.

For small hospitals operating on thin margins, the new fee makes hiring foreign healthcare workers financially unviable. Many administrators warn that without access to H-1B staff, they will be forced to shut down departments or close entirely.

The American Medical Association, along with 53 other medical organisations, urged the Department of Homeland Security to exempt physicians, residents and fellows from the new fee. The groups argued that the government should “consider H-1B physicians’ entry into the US to be in the national interest of the country, and waive the new application fee, so that H-1B physicians can continue to be a pipeline that provides health care to US patients.”

Medical deserts and human cost

The closure of rural hospitals creates what experts call medical deserts. According to a GoodRx study, nearly 80 percent of US counties now qualify as medical deserts. Almost 40 percent are trauma-care deserts, where patients must travel more than an hour to reach a facility capable of treating serious injuries.

The consequences are severe. Rural Americans already face higher rates of chronic illness, obesity and premature death than urban populations. Losing local healthcare infrastructure worsens these disparities.

When Glenn Medical Centre shut down in California, more than 28,000 people were left without local hospital access in a county with one of the state’s highest cancer rates.

“People missing out on care, people having delayed care, diagnoses weren’t made,” said Dr Brady Didion, a family physician who worked at a rural Wisconsin hospital that later closed. “A lot of people and families suffered.”

Emergency responders see the fallout firsthand. “They’re more sick when we see them. And so you’re kind of watching them decompose almost in the back of the ambulance,” paramedic Brooklyn Sommerfield told ABC News.

Who will be hit hardest

Experts warn that Trump’s H-1B policy will hit the most vulnerable Americans hardest.

Dr Michael Liu, a resident physician and co-author of the JAMA study, warned that “the most socio-economically vulnerable communities will be hit hardest in terms of health care worker supply and care access,” adding that “millions of Americans depend on” foreign healthcare workers for timely care.

Despite legal challenges and mounting criticism, the fee hike remains in place. While the administration argues that restricting H-1B visas protects American workers, the reality in rural healthcare tells a different story.

By making it harder for hospitals to hire the staff they desperately need, the policy risks accelerating hospital closures, expanding medical deserts and leaving millions of Americans without timely access to care.

In rural America, the cost of this decision will not be measured in dollars, but in delayed diagnoses, preventable deaths and communities left without a safety net.