The Trump administration’s introduction of an unprecedented $100,000 fee for new H-1B visa applications, effective September 21, 2025, has sent shockwaves through the immigration landscape. This dramatic increase representing a tenfold jump from the previous $2,000-$5,000 average cost has sparked widespread confusion and concern across multiple sectors.
Primary Concerns:
- Who has to pay the $100,000 fee?
- Are universities and hospitals exempt?
- Does it apply to current H-1B holders?
- Can international students still transition from F-1 to H-1B?
Who Does the H-1B $100,000 Fee Apply To?
According to USCIS guidance issued in October 2025, the $100,000 supplemental fee applies specifically to:
New H-1B petitions filed on or after September 21, 2025, for beneficiaries who are:
- Outside the United States at the time of filing
- Do not hold a valid H-1B visa
- Are seeking initial H-1B status through consular processing
The fee must be paid via the US Treasury’s website pay.gov before USCIS will approve the H-1B visa application. This represents a dramatic increase from the previous $2,000-$5,000 average cost for H-1B petitions, creating significant financial barriers for employers seeking to hire international talent.
Importantly, this fee applies regardless of whether the employer is a for-profit company, nonprofit organization, university, or hospital. Cap-exempt employers—including universities, nonprofit research institutions, and hospitals affiliated with institutions of higher education—are not automatically exempted from this fee, despite their historical exemption from the H-1B lottery cap.
Who Does the H-1B $100,000 Fee NOT Apply To?
USCIS has clarified several important exemptions to the $100,000 fee requirement:
Current H-1B Status Holders:
- Individuals who already hold H-1B status in the United States are exempt from the fee
- This exemption continues even if the H-1B holder travels internationally and returns to the US
- Extensions and renewals with the same employer do not trigger the fee
Change of Status, Amendments, and Extensions:
- H-1B petitions filed on or after September 21, 2025, requesting a change of status from another visa category (such as F-1 student status) to H-1B
- Amendment petitions for current H-1B holders
- Extension of stay petitions for current H-1B holders
- These exemptions apply as long as the beneficiary is already in the United States when the petition is approved
Petitions Filed Before September 21, 2025:
- Any H-1B petition filed before 12:01 a.m. EDT on September 21, 2025, is exempt
- Visa stamp applications at US Consulates abroad based on petitions filed before this date are also exempt
Transfer to New Employer:
- Current H-1B holders transferring to a new US employer (H-1B portability) are exempt from the fee
- This applies even if the transfer petition is filed after September 21, 2025
Impact on Hospitals and Universities
The $100,000 fee has created significant controversy within the healthcare and higher education sectors, as cap-exempt employers—including universities and nonprofit hospitals—are not automatically exempted from the fee.
Current Status for Universities and Hospitals:
Despite decades of cap-exempt status under the Immigration and Naturalization Act, which exempts institutions of higher education and affiliated nonprofit hospitals from the annual H-1B lottery cap, the September 2025 proclamation does not provide an automatic exemption from the $100,000 fee for these institutions. This means:
- Universities filing new H-1B petitions for faculty, researchers, and staff from abroad must pay the $100,000 fee
- Nonprofit hospitals affiliated with institutions of higher education must also pay the fee for new hires
- This applies even though these institutions have historically been recognized for their special role in the national interest
Advocacy Efforts and National Interest Exemptions:
Multiple organizations have urged the Department of Homeland Security to exempt healthcare and educational institutions:
The American Medical Association (AMA), along with over 50 medical specialty societies, sent a letter to DHS Secretary Kristi Noem requesting that all physicians—including medical residents, fellows, researchers, and those in nonclinical settings—be exempt from the fee. The letter emphasized that 23% of licensed physicians in the US are international medical graduates (IMGs), with approximately 64% practicing in medically underserved or health professional shortage areas.
The American Hospital Association (AHA) urged exemptions for all healthcare personnel, warning that the increased petition fees would prevent many hospitals from recruiting essential health care staff and could force reductions in services provided.
The Association of American Veterinary Medical Colleges (AAVMC) and 29 higher education associations called for colleges and universities to be exempted, noting that H-1B beneficiaries at these institutions train domestic students in high-demand occupations, conduct essential research, provide critical patient care, and support core university infrastructure.
Potential National Interest Exceptions:
The proclamation allows the Department of Homeland Security to grant case-by-case or industry-wide exemptions if determined to be in the national interest. Potential candidates for national interest exceptions include:
- Physicians working in federally designated Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas/Populations
- Community and safety-net hospitals
- J-1 waiver placements through State Conrad 30 Programs
- H-1B petitions filed by colleges, universities, or nonprofit hospitals affiliated with institutions of higher education
- Healthcare workers in rural and underserved areas
However, as of November 2025, no formal guidance has been issued regarding eligibility criteria, application procedures, or required documentation for national interest exceptions. This lack of clarity creates uncertainty for healthcare employers and academic institutions that rely on international talent for staffing and research.
Impact on Rural and Underserved Communities:
The fee poses particular challenges for rural hospitals and underserved communities:
- Rural and community hospitals operate on narrow profit margins, making the $100,000 fee per physician financially prohibitive
- More than 20 million Americans live in areas where IMGs account for at least half of all physicians
- The fee could result in unfilled physician positions, reduced services, and longer wait times for patients in areas that already struggle to attract US medical graduates
- Healthcare employers may be forced to divert funds from clinical programs, community health investments, or local recruitment incentives to cover visa fees
The Association of American Medical Colleges projects a shortage of up to 86,000 physicians by 2036, highlighting the critical role that international medical graduates play in filling this void, especially in high-need areas of the country.