Today, that menu has expanded.
Companies can outsource jobs to other countries.
Artificial intelligence is replacing some types of work,
and other countries, like Japan,
have shown the possibilities of robotics.
But many services still require humans,
in person.
“If you’re an obstetrician, delivering a baby right in the moment,
you need hands to lay on the patient,”
said David Goldberg,
a vice president of Vandalia Health,
a network of hospitals and medical offices in West Virginia.
“It’s not the same as a banker,
or someone creating code.”
Nearly a fifth of nursing positions are currently vacant in West Virginia
— a state that is older,
sicker and poorer
than most
— and the state faces a serious shortage of physicians in the coming years.
The answer has been to look abroad.
A third of West Virginia’s physicians graduated from medical schools overseas.
Now that option is narrowing.
“We lost two cardiologists because of their concern that they wouldn’t get their visa
and, if they did,
that they would not be able to stay here permanently,”
Mr. Goldberg said.
“They went elsewhere.”
Similarly, nobody has figured out how to harvest delicate crops with machines.
During the
low-immigration 1970s,
some crops, like green onions,
disappeared from shelves or were imported instead.
“It’s not going to hop from the ground into a package without somebody’s hands being involved somewhere along the way,”
said Luke Brubaker,
who runs a dairy farm with his sons and a grandson in Pennsylvania.
To milk cows,
feed them and deliver calves,
he relies on more than a dozen foreign-born workers,
most of them Mexican.
He is not optimistic that he will be able to replace them.
“You can put an ad in the paper,” he said.
“Maybe you would have one American-born applying for that job if you need 10 people.
And that’s a maybe.”
For now, Mr. Brubaker can still find staff.
The surge of immigrants who entered the United States under President Biden
— more than eight million people
— means that many foreign-born workers are still available.
That surge helped create an
anti-immigrant backlash,
inflaming fears about crime and jobs.
It also stung immigrants who felt they had faced higher barriers than newer ones from places like Venezuela.
“The Mexican population felt that it was not fair,”
said Alfonso Medina,
who owns La Carreta,
a Tex-Mex restaurant in Marshalltown
started by his father,
a Mexican immigrant, in 2000.
“Imagine you’re here for 20, 30 years contributing.
And all of a sudden here comes this administration and starts letting people in right away with a permit.
They felt betrayed.”
In 2024, they shifted toward Mr. Trump.