In the coalfield regions of West Virginia, a doctor from Afghanistan is treating more than 1,600 patients annually, many of them poor and elderly and living hours away from the nearest specialist. But his ability to continue that work hangs in legal uncertainty as new Trump administration immigration policies threaten to upend the lives of thousands of foreign-born physicians who have become essential to America's healthcare system.
The doctor, identified here as Ali to protect his immigration case, arrived in West Virginia in 2020 with a specialized visa designed to attract skilled foreign workers to underserved areas. He works in internal medicine at a large hospital, managing complex cases of liver disease and diabetes among patients who often lack other medical options. His colleagues describe him as dedicated and precisely the kind of physician the region desperately needs.
But Ali is now caught in a freeze. The Trump administration has paused processing of green card applications for immigrants from 39 countries, including Afghanistan, while those individuals remain in the United States. His current visa status expires this fall, and unless the government either renews it or approves his pending green card application, he will lose his job despite being able to legally remain in the country with his American-born children.
The freeze has triggered legal challenges, and a federal judge recently ruled that the government must resume processing. The Trump administration is appealing that decision, leaving Ali and thousands like him in limbo.
Ali's predicament illustrates a less publicized dimension of Trump's immigration agenda: not just restricting entry or deporting undocumented immigrants, but stripping legal status from foreign nationals already working in the country. The consequences are rippling through hospitals, especially in rural America.
About one in six hospital workers directly involved in patient care is an immigrant, and roughly 4 percent of all hospital workers are not naturalized citizens. Nearly one in four doctors practicing in the United States was trained abroad. Rural hospitals have become especially dependent on this foreign-born workforce because American physicians rarely choose to practice in remote, economically depressed areas.
West Virginia exemplifies the crisis. The state has the second-highest cancer death rate in the nation and one of the lowest life expectancies. Rural counties like McDowell, once home to over 100,000 residents and nicknamed "Little New York" in the 1940s, now have fewer than 17,000 people. Recruiting doctors to such communities has become nearly impossible. One West Virginia hospital spent four years unsuccessfully trying to hire an obstetrician-gynecologist before shutting down its obstetrics program entirely.
"International medical graduates are more likely than US medical graduates to practice in rural areas," said Dr. Jan Carney, president of the American College of Physicians, a national organization of internal medicine doctors. "We're worried about the impact of the administration's frequently changing immigration policies. These physicians are absolutely critical for the health of our communities, especially our rural and under-served residents."
Ali's path to West Virginia reflects a common pattern among foreign doctors. He was born in a village north of Kabul during years of constant warfare. His father was the village's only physician, watching children die from treatable infections due to lack of resources. After eye surgery in Pakistan as a child sparked his determination to become a doctor, Ali eventually secured an international scholarship for war-affected Afghans to attend medical school in the Middle East.
He first came to the United States in 2009 for a research program in Pennsylvania, where he contributed to developing a medication later approved by the FDA. He moved to the Midwest to study cancer genetics before accepting the H-1B visa in 2020 that brought him to West Virginia during the peak of the COVID-19 pandemic.
His wife and two children, both born in America and English-speaking, have settled into their community. His son attends school; his daughter is a toddler. But the family faces an impossible choice. If Ali loses his legal status, they would need to leave the country. Yet returning to Afghanistan is not an option. Ali belongs to an ethnic group that opposed the Taliban and worked with the United States during its occupation. "The Taliban probably will kill me," he said.
The administration's policy represents a sharp departure from how the immigration system traditionally functioned. People who apply for green cards can typically remain in the country while their applications are reviewed. The new pause breaks that precedent and creates legal chaos for thousands of professionals already contributing to the American workforce.
For West Virginia's most vulnerable residents, the consequences are direct and measurable. Patients in remote parts of the state travel hours to reach hospitals where foreign doctors like Ali work because specialists are unavailable closer to home. In some of the poorest regions, some towns have lacked safe drinking water for years, and the only economic alternatives are coal mining or military service. Healthcare, however inadequate, often depends on recruiting physicians from abroad willing to practice in communities most American doctors avoid.
Author James Rodriguez: "The Trump administration is solving an immigration problem by creating a healthcare crisis in exactly the communities that can least afford it."
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