A major change by the Donald Trump administration is quietly reshaping who can hire foreign workers in the US, and who can’t. Since September, companies have to pay a massive $100,000 fee for certain new H-1B visas. For many smaller employers, that has effectively slammed the door shut.

Trump’s H-1B changes leave smaller employers struggling

According to the government data, between September 21 and mid-February, H-1B applications from employers not subject to the yearly cap, like universities and some hospitals, dropped by around 15% compared to the same period last year. And by mid-February, only 85 payments of the $100,000 fee had been made.

The numbers in the initial months were just 70 and have only seen a slight recent surge, but overall remain quite low. Even so, demand for the visa remains high. Each year, only 85,000 visas are available, and applications usually far exceed that number.

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What USCIS data says

New data from the US Citizenship and Immigration Services shows that demand for H-1B visas has taken a noticeable dip this year. For FY 2026, eligible registrations fell to 343,981, down from 470,342 the year before. That’s roughly a 27% drop. The number of unique applicants, or beneficiaries, also went down by about 20.5%.

Hospitals warn patient care could suffer

The biggest impact is showing up in healthcare, especially in smaller and rural areas. 

A case in North Carolina’s  Nephrology Associates of the Carolinas came to light, where the team is trying to hire a doctor from India. They applied for a fee waiver, which is only given if the worker is considered to be in the “national interest”,  but it was denied. Now they’re not sure they can move ahead. The $100,000 fee is a huge burden for a small practice, and they are even considering taking a loan.

One expert speaking to the NYT said they have seen about a 50% drop in clients applying for H-1B visas this year.

At the Wayside Youth & Family Support Network, the impact is very real. The nonprofit runs a private special education school and has always struggled to find enough local teachers. To manage, they used the H-1B program to hire educators from countries like Brazil, Mexico and Germany. Right now, they have five teaching positions open, roles they would normally try to fill through this visa route. But that’s no longer possible. “The $100,000 fee has closed the door for us,” Sara McCabe, the organisation’s president, told NYT.

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This isn’t just about one fee. A series of changes is slowly reshaping who can actually use the H-1B program.

In February, new rules came in that give preference to higher-paying jobs when visas are handed out. Around the same time, the Labour Department proposed raising the minimum wages that companies must pay H-1B workers.

Put together, these changes are shifting the program toward higher-paid roles and bigger employers.

Startups and small firms face a tough choice

Smaller firms, nonprofits and rural hospitals are feeling it the most. Many of them simply cannot afford the new costs or match the salaries offered by big tech companies. A lot of IT consulting firms and other companies that rely heavily on hiring from overseas have also cut back on applications.

There isn’t full official data yet, breaking down companies by size for 2026 filings. But early analysis shows that smaller firms are clearly at a disadvantage. At the same time, new wage rules being discussed by the US Department of Labour could add more pressure. These proposals could raise wages for H-1B workers by around $20,000 per employee on average.

For some small businesses, that’s a serious hit:

  • Up to 18% of small H-1B employers could see wage increases crossing 3% of their total revenue
  • In sectors like computer programming, that number could jump to 49%
  • The smallest firms, earning under $1 million, could see impacts of over 10% of their revenue

On the other hand, large tech companies have mostly avoided the hit. They usually hire international students who are already in the US and switch their visa status, which means they don’t have to pay the new fee.

However, there are multiple instances that show not every small organisation is avoiding hiring—some really don’t have any option. At Northern Light AR Gould Hospital, the team decided to go ahead and pay the $100,000 fee to hire a German general surgeon, as they had been struggling to fill the position for the last three years.

Small businesses play a huge role in the US economy. In recent years, they’ve been responsible for about 55% of new job creation. If they struggle to hire skilled workers, it doesn’t just affect them, it can slow down growth more broadly.