As the White House raises the costs of H-1B visas to an unprecedented $100,000, new research finds that rural and high-poverty communities rely the most on international physicians who get the permits to enter the country.

An analysis of 11,080 physicians who are staying in the US on H-1B visas in the fiscal year 2023-2024 found that they make up 2.0% of the workforce in highest-poverty counties vs 0.54% in the lowest-poverty counties (difference, 1.3%; 95% CI, 1.01%-1.5%; P < .001), reported clinical fellow Michael Liu, MD, MPhil, of Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital, Boston, and colleagues in JAMA.

Rural counties had nearly double the percentage of H-1B physicians compared with urban counties (1.6% vs 0.95%, respectively; difference, 0.48%; 95% CI, 0.29%-0.66%; P < .001).

“We were struck by the substantial variation in the share of H-1B physicians,” Liu told Medscape Medical News. “Creating barriers to these visas could result in considerable access issues for patients.”

H-1B visas typically allow individuals to stay in the US for 3 years, and international physicians often rely on them to gain access to the country on a temporary basis. The cost of the visas has been around $3500, according to the study, but the Trump administration in September 2025 raised the fee to $100,000.

According to Liu, H-1B visas can be renewed for a maximum of 6 years, or longer if an applicant is proceeding to get a green card, which allows permanent residency. Nearly 400,000 immigrants in the US have H-1B visas, Liu said.

Overall, international physicians in the US on H-1B visas only make up 0.97% of all physicians, the study reported. Still, “in some communities, they make up 1 in 4, 1 in 3, or even 1 in 2 doctors,” Liu said.

In an accompanying commentary, Omar Abughanimeh, MBBS, assistant professor at the University of Nebraska Medical Center-Fred and Pamela Buffett Cancer Center, Omaha, Nebraska, and gastroenterologist Mouhanna Abu Ghanimeh, MBBS, of Sanford Health, Sioux Falls, South Dakota, note that international medical graduates (IMGs) make up one fourth of practicing physicians in the US.

Between 2001 and 2020, 18,504 of these graduates stayed in the US via a program that granted them H-1B visas if they agreed to serve for 3 years in an underserved area.

“A policy like this will make employers think twice before hiring physicians with H-1B visas, given the cost and legal challenges with all recent policies,” they wrote. “This new rule will not magically create more local physicians for rural towns or safety-net clinics. Instead, it will mean longer waits and care farther from home for people who already struggle to be seen.”

They add that “physicians in the H-1B program have proven over the years to serve diverse communities across the US, becoming a crucial part in the healthcare system. Exempting physicians and hospitals from the proposed fee is, therefore, in the national interest.”

Bobby Mukkamala, MD, president of the American Medical Association (AMA) and otolaryngologist — head and neck surgeon, told Medscape Medical News that the new fee will hurt areas already struggling with physician shortages.

“I live in Flint, Michigan. We’re not rural, but we’re very underserved, and we have 30-some IMG residents that are coming every year to our hospital to work and help us.”

Mukkamala said his hospital, Hurley Medical Center, Flint, Michigan, won’t be able to adapt to the new costs. “There’s no way that this inner-city, single, not-big hospital is going to be able to afford $100,000 per physician to come in,” he said.

Mukkamala’s radiologist father and pediatrician mother, IMGs from India, arrived in Flint in 1970 to practice.

“When they came here to fill these positions, Hurley Hospital rolled out a red carpet because Hurley needed them,” Mukkamala said. “Now that culture seems to have changed.”

The AMA and dozens of other medical organizations are pushing the White House to exempt physicians from the $100,000 fee.

Mukkamala noted that the policy could have immediate consequences because residents are currently figuring out where to apply for positions that start in June 2026.

According to him, physician residents might say, “You know what, I don’t know if they’re going to ever fix this. And I know the hospital is not going to be able to pay this. I’m going to go somewhere else. They might go to a different country instead of the US, and that leaves us at a disadvantage.”

For the study, researchers analyzed H-1B application data from the Department of Labor for 2023-2024, when 94% of applications were approved.

Healthcare workers in the US via these visas accounted for 0.97% of physicians (11,080 of 1,138,056), 0.02% of advanced practice providers (122 of 641,605), 0.40% of dentists (1004 of 251,551), and 0.07% of podiatrists, chiropractors, and optometrists (132 of 181,495).

The highest percentages of H-1B visa holders were in the Northeast (1.4%), followed by the Midwest (1.2%), South (0.82%), and West (0.53%).

The authors noted that the study may overestimate the number of healthcare workers who ultimately enter the US via H-1B visas.

The study reported receiving no funding. One study author disclosed having relationships with the National Heart, Lung, and Blood Institute; National Institute of Nursing Research; Donaghue Foundation; Abbott; and Chamber Cardio. The other study authors, the commentary authors, and Mukkamala reported having no disclosures.