The Trump administration is proposing a new $103,265 fee for certain H-1B petitions, creating another major change to the U.S. immigration system for foreign professionals.
The announcement has received considerable attention from technology companies and international workers. But there is another group that needs to understand what this means: international nurses and U.S. healthcare employers that recruit internationally.
The good news is that the headline is more complicated than it first appears.
The proposed $103,265 fee does not apply to every international nurse seeking to work in the United States.
In fact, many internationally educated registered nurses use immigration pathways that are completely separate from H-1B.
However, nurses in certain specialized positions could be affected, and the broader changes to the H-1B program could influence how U.S. hospitals approach international recruitment.
What is the $103,265 H-1B fee?
On August 25, 2026, the U.S. Department of Homeland Security published a Notice of Proposed Rulemaking that would establish an additional $103,265 fee for H-1B petitions subject to the annual cap.
The proposal would apply to petitions under both the regular H-1B allocation and the additional allocation for qualifying applicants with U.S. advanced degrees.
According to the official Federal Register proposal, the proposed fee would be in addition to the other fees already associated with H-1B petitions.
It is important to emphasize one word:
Proposed.
As of September 8, 2026, this is not a $103,265 fee that every employer is already required to pay. The rule is going through the federal regulatory process and could still be changed before it becomes final.
DHS says the proposed fee is intended to recover a portion of the costs associated with administering the U.S. immigration system.
Why should international nurses care?
The H-1B program is commonly associated with technology workers, but healthcare employers also use H-1B sponsorship for certain positions.
That makes the proposed fee relevant to some international healthcare professionals.
There is, however, an important distinction that international nurses need to understand:
Being an international nurse does not automatically mean you need an H-1B visa.
For many internationally educated registered nurses, other immigration pathways are much more relevant.
Most registered nurses do not automatically qualify for H-1B
This is one of the most important points that can get lost in the current coverage.
According to U.S. Citizenship and Immigration Services (USCIS) guidance on nursing occupations, registered nurses generally do not qualify for H-1B classification.
Why?
H-1B is intended for specialty occupations where the position normally requires a bachelor’s degree or higher in a specific specialty.
USCIS explains that most RN positions do not normally require a U.S. bachelor’s degree in nursing, or its equivalent, as the minimum requirement for entry into the position.
That does not mean no nurse can qualify for H-1B.
Rather, the specific nursing position matters.
Certain specialized and advanced nursing positions may meet the requirements for H-1B classification when the position itself qualifies as a specialty occupation.
Therefore, the right question for an international nurse is not simply:
“Does the $103,265 fee apply to nurses?”
The better question is:
“Will my U.S. employer be sponsoring me through an H-1B position that is subject to the annual cap?”
That distinction is extremely important.
Which international nurses could be affected?
The proposed H-1B fee is most relevant to nurses whose employment position qualifies for H-1B and whose employer must file a cap-subject H-1B petition.
This could be more relevant for certain specialized or advanced nursing roles than for conventional staff RN positions.
For example, an employer recruiting an advanced nursing professional into a position that meets the specialty-occupation requirements may have a very different immigration strategy from a hospital recruiting a foreign-trained bedside RN through an employment-based immigrant visa.
The position, employer and immigration category all matter.
Not all H-1B positions are subject to the proposed fee
Another important distinction is whether the employer is cap-subject or cap-exempt.
The Federal Register proposal specifically states that the proposed $103,265 fee would apply to H-1B cap-subject petitions and would not apply to all H-1B petitions, including certain cap-exempt filings.
This can matter to healthcare professionals because certain qualifying institutions of higher education, nonprofit organizations and research organizations can be exempt from the annual H-1B cap.
You can read the detailed language in the Federal Register’s official proposed rule.
For an international nurse, this means the employer’s status can be just as important as the nurse’s occupation.
The H-1B lottery has also changed
The proposed fee is only one part of a much larger change to the H-1B program.
For FY2027, the H-1B selection process moved to a wage-weighted selection system.
Instead of giving every registration exactly the same probability of selection, the new system gives greater weight to higher-paid positions.
That means wage level can now influence an applicant’s chances in the H-1B selection process.
For international healthcare professionals, this creates another consideration.
A specialized nursing position with a higher wage may be treated differently in the selection process from a lower-paid position.
The policy direction is therefore becoming increasingly focused on higher-paid and higher-skilled foreign workers.
What happened to the previous $100,000 H-1B fee?
This is another area where the current situation can be confusing.
In September 2025, the Trump administration introduced a separate $100,000 payment requirement associated with certain new H-1B workers.
That policy was challenged in federal court.
In June 2026, a federal judge vacated the government’s implementation of that payment requirement. The administration appealed the decision.
The new $103,265 proposal is a separate measure.
The Federal Register specifically explains that the proposed $103,265 fee is based on different legal authority from the earlier $100,000 payment.
Therefore, international nurses should not interpret the current headlines as meaning that employers automatically have to pay both fees.
The legal situation surrounding the earlier $100,000 measure remains important, but it is separate from the newly proposed fee.
International nurse recruitment has already been part of the legal fight
The impact on healthcare is not hypothetical.
Global Nurse Force, an international healthcare recruitment organization, became the lead plaintiff in litigation challenging the earlier $100,000 H-1B payment requirement.
The organization has argued that policies making H-1B recruitment prohibitively expensive can interfere with the ability of U.S. healthcare organizations to recruit internationally.
You can read more about the case and its implications for healthcare recruitment on Global Nurse Force’s H-1B lawsuit page.
This is significant because it demonstrates that the H-1B debate is not simply about Silicon Valley.
Healthcare employers and international nurse recruitment organizations are directly involved.
What does this mean for internationally educated RNs?
For many internationally educated registered nurses, the most important point is that H-1B may not be the primary immigration pathway at all.
One of the most important employment-based pathways for internationally educated nurses is EB-3.
Professional nurses can qualify under the U.S. Department of Labor’s Schedule A framework, which recognizes certain professional nurses and physical therapists as occupations for which the labor certification process operates differently.
This is a completely different immigration category from H-1B.
And that means:
The proposed $103,265 H-1B fee is not an EB-3 fee.
An international RN pursuing an appropriate EB-3 pathway should not assume that the new H-1B proposal adds a $103,265 charge to their immigration process.
EB-3 could become even more important
The distinction between H-1B and EB-3 could become increasingly important for international nurse recruitment.
H-1B is a temporary nonimmigrant classification.
EB-3 is an employment-based immigrant category that can lead to permanent residence.
For an internationally educated RN whose U.S. employer is prepared to sponsor permanent employment, EB-3 may therefore be a much more relevant pathway than H-1B.
This is one reason international nurses should be careful when reading general news coverage about H-1B.
A headline about H-1B restrictions does not necessarily mean that U.S. hospitals have stopped recruiting internationally educated nurses.
The immigration pathway may simply be different.
What about Canadian nurses?
Canadian nurses are in a particularly different position.
Eligible Canadian professionals may be able to use the TN classification under the United States-Mexico-Canada Agreement (USMCA) when they meet the applicable requirements.
TN is not H-1B.
Therefore, the proposed $103,265 H-1B fee does not become a $103,265 fee for a Canadian RN who is entering the United States through an eligible TN pathway.
For Canadian nurses, the current immigration discussion should therefore be separated from the H-1B debate.
This is particularly important for U.S. hospitals recruiting nurses from Canada.
The hospital may have an immigration pathway available to the Canadian nurse that does not involve H-1B at all.
What does this mean for U.S. hospitals?
For healthcare employers, the proposed rule could create a significant financial question.
If a hospital or healthcare organization needs an H-1B worker and the petition is subject to the annual cap, an additional fee of $103,265 would be a substantial recruitment expense.
That could influence decisions about:
- which international positions employers are willing to sponsor;
- whether employers pursue H-1B or another immigration category;
- recruitment of specialized healthcare professionals;
- international recruitment budgets;
- compensation levels;
- and the use of recruitment agencies or international staffing partners.
The impact will ultimately depend on whether the proposed rule becomes final and exactly how it is implemented.
What should international nurses do?
International nurses considering the United States should not make decisions based solely on the $103,265 headline.
Instead, ask the employer or immigration attorney:
What visa or immigration category will I use?
Is it H-1B, EB-3, TN or another classification?
Is my nursing position actually H-1B eligible?
Being a registered nurse does not automatically make a position eligible for H-1B.
Is the employer cap-subject or cap-exempt?
This can determine whether the proposed $103,265 fee is relevant.
Who is responsible for the immigration costs?
Nurses should understand what their employer will pay and what costs, if any, they are expected to cover.
Could EB-3 be a better pathway?
For many internationally educated RNs, this may be the more relevant question.
If I am Canadian, could TN apply?
Canadian nurses may have a separate pathway that avoids the H-1B system entirely.
The bigger picture for international nurses
The U.S. immigration environment is clearly becoming more restrictive and more expensive for some categories of foreign workers.
But that does not mean the United States has closed its doors to international nurses.
Instead, the system is becoming more complicated.
For some nurses, H-1B could become considerably more expensive.
For many internationally educated RNs, EB-3 remains the more relevant employment-based pathway.
For eligible Canadian nurses, TN can provide a completely different route.
And for certain specialized healthcare professionals, H-1B may remain an option—but potentially under much more expensive and competitive conditions.
The biggest mistake an international nurse can make right now is assuming that one immigration policy applies equally to every nurse.
It doesn’t.
The bottom line
The proposed $103,265 H-1B fee is a major development, but it is not a $103,265 fee on international nurses.
It is a proposed additional fee for H-1B cap-subject petitions.
For international nurses, the real question is which immigration pathway applies to their specific job.
For a foreign-trained RN pursuing EB-3, the proposed H-1B fee is a different issue.
For an eligible Canadian RN pursuing TN, the H-1B proposal is also a different issue.
For specialized nurses whose employers rely on cap-subject H-1B sponsorship, however, the proposal could represent a significant new obstacle.
As the rule moves through the regulatory process, international nurses and U.S. healthcare employers should pay close attention to whether the proposal becomes final and whether its scope changes before implementation.
The U.S. is still recruiting international nurses. But understanding the immigration pathway has never been more important.
Important sources
- U.S. Department of Homeland Security / Federal Register: Fee for Certain H-1B Petitions — $103,265 proposed fee
- USCIS: Policy guidance on H-1B eligibility for nurses
- Global Nurse Force: H-1B lawsuit and international healthcare recruitment
- U.S. Department of Labor: Schedule A — Professional Nurses and Physical Therapists
- USCIS: H-1B Specialty Occupations
- USCIS: TN NAFTA/USMCA Professionals
- Federal Register: FY2027 H-1B weighted selection process
