The Trump administration’s immigration policies are creating uncertainty for hundreds of foreign-born doctors already living and working legally in the United States – and straining the rural healthcare systems that depend on them, according to a Guardian investigation that interviewed 21 physicians and multiple hospital administrators.
A central example is Ali, an Afghan doctor practicing in West Virginia who asked the Guardian to use a pseudonym and to withhold his location because of his immigration case. Ali moved to the state in 2020 on an H-1B visa requiring him to work in an underserved area. Last year he treated more than 1,600 patients, more than 80% of them on Medicare or Medicaid. He routinely manages liver diseases and complications of obesity-driven diabetes in a region where patients sometimes drive two hours to reach his hospital.
“He’s a stellar caregiver … with great foundational knowledge and ability to take care of West Virginians,” a senior colleague told the Guardian, speaking on condition of anonymity because of the sensitivity of the case.
The policies putting Ali’s career at risk began in June 2025, when the Trump administration imposed a travel ban on more than a dozen countries, later expanded to 39 nations, including Afghanistan. Then in January 2026, US Citizenship and Immigration Services paused processing green-card applications for immigrants already in the United States from those countries, saying it needed “to vet and screen aliens to the maximum degree possible.”
Ali, who has applied for a green card and was still waiting, found himself in limbo. If his visa status expires this fall without renewal or a green-card approval, he will lose his job. He and his wife can stay legally, but he will be unable to work. “You do everything by the book, abide by the laws, and you end up in this deadlock,” he told the Guardian.
Medical organizations, including the American Medical Association and the American College of Physicians, wrote to USCIS requesting an exemption for physicians. Dr. Jan Carney, president of the American College of Physicians, told the Guardian that international medical graduates “are absolutely critical for the health of our communities, especially of our rural and under-served” areas. The government later updated its website to say that holds were lifted for “medical physicians,” but did not say when pending cases would be resolved. Of the 21 doctors the Guardian interviewed, only one had their application processed; Ali and the other 19 are still waiting.
The legal landscape has shifted. In early June 2026, a federal court ruled that USCIS can no longer suspend the processing of applications from the 39 countries, adding that the policy reveals “anti-immigrant sentiments that it is forbidden from letting influence its decision-making.” USCIS is appealing the ruling. The agency said it would comply with the order in the meantime. James Percival, general counsel for the Department of Homeland Security, said in a statement that “the Left” had been using arguments about racial “animus” to go after “virtually every Trump-era Department of Homeland Security policy,” calling it “sabotage dressed in legal clothing.”
Other changes are compounding the problem. The administration imposed a $100,000 fee on H-1B visas for people applying from abroad, up from roughly $2,000 to $5,000 previously. A hospital vice president in West Virginia, who spoke anonymously because the hospital receives federal funding, told the Guardian that the fee forced his hospital to pay the six-figure sum for one doctor. He said that because of limited physicians, the hospital could only perform about 80 kidney transplants this year instead of 150, meaning 70 people would not get a kidney. A federal judge struck down the $100,000 fee on June 8; the government is also appealing that ruling.
West Virginia offers an especially stark example. The state has the second-highest cancer death rate in the U.S., one of the lowest life expectancies, and more than half its residents live in healthcare deserts, said Dr. April Vestal, who heads an institute to improve rural health in the state. Hospitals in rural counties rely heavily on foreign-trained physicians because few American doctors want to move to such areas.
Dr. Kate Waldeck, a pediatrician who has worked across the state, described filling in for a foreign doctor who was the only pediatrician in his clinic and worked 50 weeks a year. “All of these places are anchored by international physicians,” she said.
Ali, whose father was the only doctor in his Afghan village, came to the U.S. in 2009 and helped develop a medication later approved by the FDA. He now faces returning to a country where he says the Taliban would probably kill him because he belongs to an ethnic group that opposed them. His children speak only English and do not know they are different, his wife said.
A Sudanese doctor training as a cardiology fellow in the upper Midwest, who requested anonymity, said his wife, a pediatric cardiologist, is expecting their second child. “Since we cannot be employed, we won’t have health insurance. So my wife will be vulnerable during a very critical time,” he said. The hospital that offered her a job had been searching for a specialist in her field for four years.
Another Sudanese doctor who worked in a jail had to stop earlier this year because his work permit application was on hold. He trained two nurse practitioners to take over his role. He told the Guardian he spent a day calling more than 36 patients to tell them to find a new physician; seven said they could not find timely follow-up care. “What’s been especially difficult is that, legally, I’m not even allowed to continue working at my free clinic, even though I volunteer there without pay. That part has honestly been heartbreaking,” he said.
Curtis Morrison, an attorney representing Ali and dozens of other physicians from the affected countries, told the Guardian that in his experience USCIS is only processing applications from plaintiffs in the lawsuits and may be “slow-walking the implementation of the order.” The outcome of the various legal challenges remains uncertain as the administration appeals multiple rulings.