(UNITED STATES) A new presidential proclamation will impose a $100,000 H-1B fee per worker starting September 21, 2025, a sharp jump from previous charges that were generally under $5,000. The fee applies to H-1B petitions filed on or after that date for employees who are outside the country at filing, and it is slated to run for 12 months through September 20, 2026, unless extended. The announcement has sent shockwaves through the U.S. healthcare sector, where hospitals—especially in rural areas—depend on international medical graduates and foreign-trained staff to cover critical gaps.

H1B Visa $100,000 Fee Structure Table

The new $100,000 H1B visa fee represents a seismic shift in U.S. immigration policy, but its application is surprisingly targeted rather than universal. The fee primarily impacts new H1B applicants coming from abroad and those requiring visa stamping at U.S. consulates overseas. Current H1B holders within the United States are largely protected from this financial burden, as renewals, extensions, transfers between employers, and re-entries with valid visas remain exempt from the substantial fee.

This selective implementation creates a two-tiered system that heavily penalizes fresh international talent while protecting the existing H1B workforce. Employers planning to hire new foreign workers will face dramatically increased costs, potentially reshaping hiring strategies and making domestic talent acquisition more attractive. The timing of September 21, 2025, gives employers and prospective H1B workers a narrow window to file petitions under the current fee structure before the new requirements take effect.

H1B Visa Cost Comparison Table

The introduction of the $100,000 H1B fee transforms what was once a manageable immigration expense into a prohibitive financial barrier for many employers. While traditional H1B costs typically ranged from $2,000 to $5,000 for most petitions, the new fee structure catapults total expenses to between $102,000 and $105,000 or more. This represents a cost increase of approximately 2,000-5,000%, making H1B hiring one of the most expensive employment decisions a company can make.

The stark contrast becomes even more pronounced when considering that all existing fees remain unchanged—the $100,000 addition is purely incremental cost with no corresponding benefit or service enhancement. This dramatic shift will likely force employers to fundamentally reconsider their international hiring strategies, potentially favoring internal transfers, alternative visa categories, or domestic recruitment. Only the largest corporations with substantial budgets may continue pursuing H1B petitions at scale, effectively pricing out smaller employers from accessing global talent.

H1B $100,000 Fee Exemptions Table

The exemption landscape for the new $100,000 H1B fee reveals a complex web of uncertainty, with only two categories enjoying confirmed relief from the substantial financial burden. Current H1B holders with valid visas and petitions filed before September 21, 2025, represent the only “safe harbor” provisions with high certainty of exemption. These clear-cut exemptions provide crucial protection for existing H1B workers and create a powerful incentive for employers to rush petition filings before the deadline.

The majority of potential exemptions fall into a frustrating gray area, particularly affecting cap-exempt organizations like universities, research institutions, and nonprofits. While these entities have historically enjoyed preferential treatment in H1B processing, the new fee structure’s impact on their exemption status remains unclear, creating planning challenges for academic and research sectors. The “case-by-case” national interest determination adds another layer of uncertainty, offering hope but no guarantees for employers who can demonstrate compelling public benefit. This ambiguous exemption framework may prompt many organizations to seek legal clarification or pursue alternative immigration strategies while awaiting definitive guidance.

According to analysis by VisaVerge.com, employers should expect fewer entry-level and trainee H-1B roles to move forward as the policy takes effect.

Policy shift and scope

Under the proclamation, employers must pay the $100,000 fee upfront. If the fee is not paid, the H-1B petition will not proceed.

The rule applies solely to petitions for beneficiaries who are outside the United States at the time the petition is filed. Workers who are inside the country as of 12:01 a.m. on September 21, 2025 are not subject to the new charge for that petition. However, if a worker leaves the United States after that date while a petition is pending, the fee could attach depending on timing and case specifics.

Officials described the policy as part of a broader shift toward an “elite” H-1B system that favors high-wage, high-skilled professionals and moves away from lottery-based selection toward merit-based allocations. That direction follows years of debate over the H-1B program’s role in training pipelines, entry-level hiring, and wage levels.

• During 2017–2020, denial rates spiked under restrictive policies, before later falling to low single digits in 2021–2022.
• The new fee represents a major escalation and signals that lower-wage and training roles face higher barriers.

Commerce Secretary Howard Lutnick framed the move bluntly:

“No longer will you put trainees on an H-1B visa — it’s just not economic anymore. If you’re going to train people, you’re going to train Americans.”

Employers across IT and healthcare now face immediate choices: absorb the cost for select roles, switch to different visa categories where available, or pause international hiring plans entirely while seeking legal guidance.

Impact on the U.S. healthcare workforce

Hospitals and teaching institutions say the stakes are high. Roughly 30% of U.S. medical residents are international graduates, and an estimated 10,000 of the 43,000 residency positions are filled by H-1B visa holders. Many residents earn around $55,000 a year. For those roles, a $100,000 H-1B fee can be a hard stop.

Key consequences include:

• Teaching hospitals that rely on foreign-trained residents may scale back offers or switch to J-1 sponsorship, which often carries a two-year home residency requirement that limits retention.
• Safety-net and rural hospitals that already struggle to recruit may lose candidates, raising wait times and reducing specialty coverage (emergency rooms, ICUs, obstetrics, mental health, primary care).
• Specialty services could become thin in areas already short on providers; a single vacancy (e.g., cardiology) may take months longer to fill.
• Patients could face longer travel for care, more out-of-network referrals, and delays in diagnostics and treatment.

Healthcare administrators emphasize the financial impact: for a residency program with dozens of H-1B trainees, even a fraction subject to the fee would add millions to an annual budget. Finance teams will likely need to:

• Model worst-case costs.
• Decide whether to pursue narrow exceptions.
• Shift candidates to other visa categories.
• Restructure recruitment cycles.

VisaVerge.com reports that small and mid-sized hospitals will be least able to absorb the shock, while larger systems may triage sponsorship to a small number of high-impact hires.

The policy also intersects with rural health and public health priorities. Many communities rely on physicians who trained abroad to maintain 24/7 coverage. Curtailing that pipeline risks:

• Higher burnout among remaining staff
• Potential service cuts
• Patient outmigration to crowded urban centers

Those outcomes conflict with efforts to keep care local and reduce hospital closures in underserved regions.

Compliance questions and immediate next steps

Because the proclamation ties the fee to workers outside the country at the time of filing, attorneys expect intense scrutiny of travel histories and case timing. Employers should review pending and upcoming cases with counsel and plan around the core triggers outlined by the government.

Key operational points:

• Effective date and duration: Applies to qualifying H-1B petitions filed on or after September 21, 2025, and remains in effect for 12 months (through September 20, 2026), unless extended or modified.
• Geographic trigger: Applies when the H-1B beneficiary is outside the United States at filing; workers already inside at 12:01 a.m. on the effective date are generally not covered for that filing.
• Travel during pendency: If a worker travels abroad after the effective date while a petition is pending, the case could be captured by the fee; employers should discuss travel plans with counsel.
• Upfront payment: Employers must pay the $100,000 at the time of filing; otherwise, the petition will not move forward.
• Scope: The policy targets entry-level and training positions most directly, consistent with the administration’s stated goal of prioritizing high-wage roles.

Practical steps for affected institutions:

1. Map current and planned H-1B filings for the next 12 months and tag whether each worker is inside or outside the United States.
2. Identify any travel that could affect status and set internal approval gates for trips during pendency.
3. Coordinate HR, finance, and legal teams to align filings with budget and policy terms.
4. Stress-test timing for cap-subject cases and cap-exempt filings tied to nonprofit research or higher education.
5. For foreign-trained doctors, coordinate department needs, licensure, board eligibility, and hospital privileges early to avoid last-minute travel or filing errors that could trigger the fee.

When filing, the core petition remains Form I-129, Petition for a Nonimmigrant Worker, which employers file with U.S. Citizenship and Immigration Services. The form and instructions are available on the USCIS site: Form I-129. Filing teams should confirm current editions, fees, and routing before submission given the proclamation’s strict payment rule.

Broader economic and sectoral implications

Beyond healthcare, IT service firms and startups that rely on H-1B talent for entry-level roles will face similar choices:

• Pivot to remote work outside the United States
• Postpone projects
• Target a smaller number of senior hires whose wages can justify the fee

Over time, fewer early-career H-1B entrants could shrink the talent pool available for permanent roles, affecting pipeline development in both hospitals and tech employers.

Policy advocates expect legal and political pushback. Likely developments include:

• Hospital associations and medical education leaders warning of reduced access to care, especially for Medicaid-heavy and rural facilities
• State health departments raising concerns about emergency preparedness and public health coverage
• Supporters arguing the change will raise wages for U.S. workers and steer training investment toward domestic graduates

Strategic responses under consideration

Organizations are discussing several paths to respond to the new rule:

• Concentrate limited H-1B filings on senior physicians and hard-to-fill specialties while pausing trainee sponsorship
• Increase recruitment of U.S. graduates, with incentives (bonuses, loan repayment) for rural placements—though such strategies may take years to show results
• Use J-1 training routes for residents and fellows while accepting the two-year home residency requirement for many graduates
• Expand telehealth to cover gaps, recognizing hands-on care cannot be outsourced

Patient and community impacts

For families and patients, the changes may seem distant initially, then suddenly feel immediate. In small-town hospitals, losing a single H-1B resident can mean the difference between overnight coverage and an empty ward. Consequences may include:

• Longer drives for pediatric care
• Delayed specialist visits for older patients
• Reduced local access to diagnostics and timely treatment

The proclamation sets policy on paper; the real test will play out in exam rooms, ER bays, and operating theaters across the country.

Employers should act quickly: map every planned H-1B filing for the next 12 months, tag whether the worker is inside or outside the United States, and mark any trips that could affect status.

Suggested immediate checklist for employers:

• Build a communication plan for candidates explaining travel risks during case processing
• Set internal approval gates for travel that might trigger the fee
• Coordinate HR, finance, and legal teams to ensure filings align with the proclamation’s terms
• Model budget impacts and consider triage strategies for sponsorship

The coming year will likely bring fewer H-1B workers into entry-level and training roles by design. In healthcare—where international medical graduates have long filled vital posts—that contraction may land hardest in places with the fewest buffers. If patient access falters, expect louder calls for adjustments, such as carve-outs for residents, rural hospitals, or critical shortage areas.

Until then, the H-1B fee stands as a powerful gatekeeper—and a high-stakes budget line—across the healthcare map.