Rural America faces a severe shortage of primary care physicians, with only about two-thirds of the physicians needed in the next 12 years, according to a report.[1] Approximately 43 million people live in rural areas without sufficient numbers of primary care physicians, 92% of rural counties are designated as shortage areas, and 45% had five or fewer primary care physicians in 2023.[1] The number of family physicians in rural areas fell from 11,847 in 2017 to 10,544 in 2023, a decrease of 11%.[2] Rural areas depend on immigrant physicians more than three times more than expected based on their immigrant population, and about 1% of practicing physicians in the U.S. are on H-1B visas, with the number nearly doubling in rural versus urban counties.[3] Congress allows up to 30 immigrant doctors per year in each state to remain in the US after residency if they serve in rural or underserved areas.[3] Stricter immigration rules, such as raising the H-1B visa fee from $3,500 to $100,000, threaten rural health care and could exacerbate shortages.[3] Limiting physician immigration would disproportionately affect access to health care in rural areas.[5]