Within nine months, he had filled those vacancies with Filipino teachers, the majority of whom arrived on the H-1B, a visa for skilled workers in specialty occupations.

“We’ve hired the H-1B teachers because we quite simply didn’t have other applicants for those positions,” Coverdale said. “So they’re certainly not taking jobs from Americans. They’re filling jobs that otherwise just simply we would not get filled.”

Now a new $100,000 fee for H-1B visa applications spells trouble for those like Coverdale in rural parts of the country who rely on immigrants to fill vacancies in skilled professions like education and health care.

The Trump administration announced the fee on Sept. 19, arguing that employers were replacing American workers with cheaper talent from overseas. Since then, the White House has said the fee won’t apply to existing visa holders and offered a form to request exemptions from the charge.

H-1Bs are primarily associated with tech workers from India. Big tech companies are the biggest user of the visa, and nearly three-quarters of those approved are from India. But there are critical workers, like teachers and doctors, who fall outside that category.

Over the last decade, the U.S. has faced a shortage in those and other sectors. One in eight public school positions are vacant or filled by uncertified teachers, and the American Medical Association projects a shortage of 87,000 physicians in the next decade. The shortages are often worse in small, rural communities that struggle to fill jobs due to lower wages and often lack basic necessities like shopping and home rental options.

H-1B and J-1 visas provide communities an option to hire immigrants with advanced training and certification. The J-1s are short-term visas for cultural exchange programs that aren’t subject to the new fee but, unlike the H-1B, don’t offer a pathway to permanent residency.

While large companies may be able to absorb the new fee, that’s not an option for most rural communities, said Melissa Sadorf, executive director of the National Rural Education Association.

“It really is potentially the cost of the salary and benefits of one teacher, maybe even two, depending on the state,” she said. “Attaching that price tag to a single hire, it just simply puts that position out of reach for rural budgets.”

A coalition of health care providers, religious groups and educators filed a lawsuit on Friday to stop the H-1B fee, saying it would harm hospitals, churches, schools and industries that rely on the visa. The Department of Homeland Security declined to comment and referred a query to its website.

Filling classrooms where Americans won’t go

Coverdale said spots like Stephan, where Crow Creek is based, struggle to attract workers in part because of their isolation. Stephan is nearly an hour’s drive from the nearest Walmart or any place that sells clothes, he said.

“The more remote you are, the more challenging it is for your staff members to get to your school and serve your kids,” he said.

Among Coverdale’s hires is Mary Joy Ponce-Torres, who had 24 years of teaching experience in the Philippines and now teaches history at Crow Creek. It was a cultural adjustment, but Ponce-Torres said she’s made friends and Stephan is now a second home.

“I came from a private school,” she said. “When I came here, I saw it was more like a rural area … but maybe I was also looking for the same vibe, the same atmosphere where I can just take my time, take things in a much slower pace.”

Many immigrants like Ponce-Torres leave their family behind to pursue the experience and higher wages that a U.S. job can provide.

Sean Rickert, superintendent of the Pima Unified School District in Pima, Arizona, said he would stop seeking H-1B teachers if the new fee is imposed. “I just plain don’t have the money,” he said.

Though schools can also use J-1 visas to bring in immigrant teachers, it increases turnover because it is shorter term.

“It’s so important that we find permanent people, people who can buy homes, who can become part of our community,” said George Shipley, superintendent at Bison Schools in the town of Bison, South Dakota. “So the H-1B opens that possibility. It is super important, in my opinion, to actually transition from the J-1 visas to the H-1B.”

Without enough staff, schools may hire uncertified teachers, combine classes, increase caseloads for special education managers or drop some course offerings. Shipley said any future shortage of teachers in Bison would force some classes to move online.

The rural reliance on immigrant teachers is concentrated on harder-to-fill specialties, Sadorf said.

“It’s a lot more difficult to find a high school advanced math teacher that’s qualified than it is to fill a second or third grade elementary class position,” she said.

Closing gaps in the nation’s doctor shortage

The fee could be a “huge problem” for health care, said Bobby Mukkamala, president of the American Medical Association and a doctor in Flint, Michigan. Without enough doctors, patients will have to drive farther and wait longer for care.

One-quarter of the nation’s physicians are international medical graduates, according to the AMA.

“It’s just going to be terrible for the physician shortage, particularly in rural areas,” said Mukkamala, whose parents came to the U.S. as international medical graduates. “The people that do graduate from here, who want to practice medicine, obviously have a choice and they’re going to pick Detroit, they’re going to pick Chicago, New York, Los Angeles, San Francisco. … This is kind of where everybody goes.”

Leading medical societies have called on the Trump administration and lawmakers to grant exemptions from the fee to immigrant health care workers.

“Given the staffing and financial challenges our hospitals are already facing, the increased petition fees outlined in the September 19 Proclamation would likely prevent many of them from continuing to recruit essential health care staff and could force a reduction in the services they are able to provide,” the American Hospital Association said in a statement.

Allison Roberts, vice president of human resources at Prairie Lakes Healthcare System in Watertown, South Dakota, said the change could be dire for health care in rural America.

“If we end up not being exempt, the variation between what it is now and that $100,000 fee is going to really take your smaller, rural health care institutions out of the picture,” she said.