Changing Systems: How States Can Lead in Unlocking Immigration to Meet Their Talent Needs

Over the past year, federal policy and enforcement have dominated headlines about immigration, sidelining state and local leaders from decisions that directly shape their communities. But governors are stepping forward to remind the nation of the important role states play: they create and maintain the infrastructure that affects their constituents’ lives, from building bridges and roads to hiring teachers and educating students. State and local communities are where federal policies truly come to life.

One governor recently asked why states are left out of setting immigration policy, given that it influences whether businesses can find workers, whether families can access services they need, and whether core state industries stay afloat. Immigration policy, like other federal policies, plays out most visibly in state and local communities. That means it affects manufacturing in Ohio, agriculture and food processing in Oklahoma, and, in nearly every state, health care. A pressing national shortage of health care professionals is already closing hospitals, limiting options for families seeking nursing home care, and leaving rural communities without basic services like primary care.

If states and the federal government worked together on a cohesive strategy to attract immigrants and support their economic inclusion, they would strengthen our current and future workforce and promote shared prosperity for all.

But states don’t need to wait to be invited to the table. They already have the tools to forecast population and workforce needs, to build the infrastructure that connects immigrants to good work, and to know what skills and talent they need to attract to maintain a vibrant economy.

Health Care: The Clearest Case for Action

Regarding immigration and immigrant economic inclusion, nowhere is the case for state and local leadership more urgent or more actionable than in health care. The physician shortage, projected to reach 86,000 by 2036, is already felt in 65 percent of rural communities that lack enough primary care physicians. State and local leaders know these numbers not as statistics, but as the personal experiences of their constituents. I know this both as a professional and as a loving daughter of a father in long-term care.

States are also closer to the solution than they may realize. An estimated 2 million college-educated immigrants are underemployed or unemployed in the United States—approximately 270,000 of them with health-related degrees. Trained, working-age adults from across the globe are eager to join our health care workforce. This is a systems problem, and building systems that help local communities is exactly what state and local leaders do.

Attracting Talent

The U.S. must have a strategy to attract immigrants to offset changing demographics and slowing labor force growth. Between 2000 and 2022, the U.S.-born prime working-age population (ages 25 to 54) remained nearly flat, while the number of people of prime working age born outside the U.S. grew by almost 7 million. In short, there are not enough U.S.-born workers to fill shortages across key industries.

This is not a new phenomenon—immigrants have long played a critical role in expanding the U.S. labor force. Over the past two decades, immigrants accounted for roughly 75 percent of all prime-age labor force growth. Recent efforts to align U.S. talent with workforce needs, such as outlined in the Bipartisan Policy Center’s call for a national talent strategy, are vital but not enough. States like Michigan have formally acknowledged that their economic resilience depends on attracting immigrants. Michigan’s Sixty by 30 Strategic Plan includes creating pathways for immigrants, and state policy leaders have consistently emphasized that immigrants are essential to long-term economic growth.

Filling gaps in health care and beyond will require a comprehensive immigration strategy—one that attracts immigrants, ensures safe and legal pathways that grant work authorization and opportunities for permanent residence, and ensures immigrant talent is realized in our health care workforce. States are essential partners in making that strategy work; they know what they need and are the architects of how immigrant talent is unlocked.

Unlocking Talent

Addressing workforce gaps will require both welcoming internationally trained and skilled professionals and building smarter systems to utilize the talent already in our communities.

In South Dakota, the projected nurse shortage by 2030 is the third-highest in the nation, yet its residents who hold international credentials and experience often work outside health care entirely. States frequently lack pathways to recognize credentials and experience earned abroad, leaving capable residents on the sidelines of the growing health care crisis. With improved skills recognition and clear licensure pathways, these professionals could move into in-demand roles immediately, without displacing U.S.-born workers.

States don’t need to wait for federal action to create functional systems that enable immigrants to contribute to their communities and fill workforce gaps.

South Dakota’s registered nursing apprenticeship program offers a replicable model: Internationally trained nurses complete a medical language course designed for non-native speakers of English, a licensing exam preparation class, and hands-on training alongside experienced nurses. It’s exactly the kind of locally built model that other states can learn from. When credential recognition is coordinated, licensing is streamlined, and training aligns with employer needs, states can move people from the margins into the workforce faster.

When state efforts become coherent infrastructure, supported by national coordination and a pragmatic immigration system, the results follow: Workers with skills and talent immigrate, trained nurses move into a clinical role without delay, physicians can practice medicine without repeating lengthy training, and the workforce gap narrows. Thriving communities meet the needs of immigrants and long-time residents alike.

From Local Solutions to National Resilience

The states experiencing the far-reaching consequences of the health care shortage are also best positioned to lead by executing the two strategies required to meet the moment.

The first is improving systems that leave behind immigrants already here, including the thousands of unemployed or underemployed immigrants who hold health-related degrees. Streamlining credential recognition and licensing pathways can be enacted at the state level and tailored to meet community needs.

The second is facing demographic reality head-on. The U.S.-born working-age population is not growing fast enough to fill the gaps in health care and beyond. Attracting immigrants and ensuring safe, legal pathways to work are critical to helping communities provide essential services and remain vibrant.

States that build smarter systems for local talent, while making the case for a federal immigration strategy grounded in workforce realities, are the ones best poised to host thriving economies and communities.

Kit Taintor