REGIONAL — Even before the latest change in federal visa policy, rural Minnesota clinics were fighting an uphill battle to find and keep doctors. Now, with the Trump administration increasing the H-1B visa application fee to $100,000, hospital systems and health groups say the challenge of staffing small-town health care could soon become far worse.
Across much of northern and rural Minnesota, the shortage of doctors is no secret. A 2024 report from the state Department of Health found that only a small fraction of the state’s 28,000 licensed physicians practice outside metro areas, even though rural counties make up nearly half of Minnesota’s geography. To keep clinics open, many communities now depend on nurse practitioners and physician assistants serving as lead providers in family medicine and various specialty areas.
The state’s Office of Rural Health and Primary Care reported in 2022 that the COVID pandemic further deepened staffing shortages as burnout and early departures accelerated across nearly every health profession.
The report also found that one in three rural physicians planned to leave the workforce within five years, and that the state’s rural doctors are, on average, a decade older than their urban peers. As those doctors retire, advanced-practice providers are filling more of the gap, but they can’t replace physicians in certain specialties.
With nearly a quarter of rural Minnesotans projected to be 65 or older by 2030, demand for care is climbing just as the supply of doctors continues to shrink.
Rural health administrators warn that the new visa fee could make it even harder to recruit replacements as veteran doctors retire and open positions go unfilled.
The impact of the new visa fee is already on the minds of Essentia Health, which operates hospitals and clinics across northern Minnesota and runs a community health clinic in Ely. In a statement provided to the Timberjay on Tuesday, the health system said the change could make it even harder to attract physicians to rural areas where retirements are mounting and vacancies are difficult to fill.
“The new application fee does not make these recruitment efforts easier,” the health system said. “We are continuing to explore how this proclamation may impact our future recruitment efforts and remain committed to attracting top talent to support exceptional patient care.”
That local reality mirrors what national groups are warning in Washington. The National Rural Health Association has asked the Department of Homeland Security to exempt health care workers from the $100,000 fee, calling it “cost prohibitive for rural providers.” NRHA’s analysis shows that in 2025 more than 560 rural employers nationwide relied on H-1B visas to bring physicians and practitioners to their communities.
The American Medical Association joined the appeal, supported by over 50 medical specialty societies. Their joint letter said international medical graduates are vital to maintaining patient access, particularly outside major cities. Roughly one-quarter of all licensed U.S. physicians were educated abroad, and about two-thirds of them practice in underserved rural and low-income areas.
The AMA estimates the U.S. will face a shortage of up to 86,000 physicians by 2036.
The new visa cost, effectively a six-figure hiring tax, would strain or break health care provider budgets already stretched thin. They operate with little margin and can’t absorb such a jump in recruitment expenses.
In 2024, about 16,900 of nearly 400,000 H-1B petitions nationwide were for medical and health occupations, roughly half of them physicians and surgeons. Those doctors fill vacancies that have often remained open for months or years.
The Department of Homeland Security has so far taken no action to exempt health care workers from the new fee, even though it has the authority to do so for occupations deemed essential to the national interest. While individual employers can request case-by-case waivers, groups like the NRHA and AMA say that process is unworkable for small hospitals and clinics with limited administrative staff.
The NRHA called its request for an exemption “the simplest path forward.” For rural Minnesota, it may be the most practical one.