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The Whole Story with Anderson Cooper
30 Days Inside, Hospitals And The Immigrant Workforce. Aired 8- 9p ET
Aired October 04, 2026 - 20:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[20:00:00]
OMAR JIMENEZ, CNN ANCHOR: He played the national anthem on his saxophone.
(VIDEO CLIP)
JIMENEZ: Just incredible. And thank you for joining me tonight and for joining this summer. Jessica Dean is back next weekend. I'm Omar Jimenez. I'll see you when I see you. And remember, if you're in the U.S., you can now stream CNN whenever you want on the CNN app, visit CNN.com/Watch for more.
"THE WHOLE STORY WITH ANDERSON COOPER" starts right now.
ANDERSON COOPER, CNN ANCHOR: I'm Anderson Cooper. Welcome to THE WHOLE STORY.
While the Trump administration has cracked down on illegal immigrants in the U.S., they've also moved to limit legal immigration in part, they say, to save American jobs for American workers. But hospitals across the country are increasingly turning to an immigrant workforce to fill jobs for doctors and nurses and technicians.
The health care industry has been facing a labor gap for well over a decade, a shortage that only worsened after the COVID-19 pandemic. It's especially critical in rural areas where hospitals have struggled to attract applicants. One of them is West River Hospital in Hettinger, North Dakota. Hettinger is close to South Dakota and Montana and provides medical services to all three states. More than 13 percent of their full time staff moved there from other countries taking jobs and in some cases were left open for years.
CNN's Ed Lavandera and his team spent 30 straight days filming inside this hospital, following doctors and nurses from the E.R. to the operating rooms, to show you the reality of life inside a small town hospital and how much they rely on immigrant labor. They were given full permission to film from the hospital and the patients you're about to see in this next hour.
(BEGIN VIDEOTAPE)
UNIDENTIFIED FEMALE: Hettinger Hospital, how can I help you?
ED LAVANDERA, CNN SENIOR NATIONAL CORRESPONDENT: Do you feel like we've gotten a grasp of what challenges you guys face?
UNIDENTIFIED FEMALE: I hope so.
UNIDENTIFIED FEMALE: No response, ma'am. No response.
UNIDENTIFIED FEMALE: We'll probably just let her pass.
(CROSSTALK)
UNIDENTIFIED FEMALE: OK. You're working hard.
(CROSSTALK)
UNIDENTIFIED FEMALE: All right. Setting up some fluids. Let's start it.
UNIDENTIFIED FEMALE: Tonight when he got home he was vomiting.
UNIDENTIFIED FEMALE: I'm going to do bloodwork and make sure there's not stress on your heart.
UNIDENTIFIED FEMALE: Are you sure on that oxygen?
UNIDENTIFIED FEMALE: Yes.
UNIDENTIFIED FEMALE: She had abdominal pain. It got worse.
UNIDENTIFIED FEMALE: Your surgery is done. We're just waiting for you to wake up.
UNIDENTIFIED MALE: You're pretty high risk for having a heart attack.
UNIDENTIFIED FEMALE: We'll check the baby's movement. Coming so soon. It's coming soon, yes. Everything looks good. Nothing to worry.
UNIDENTIFIED FEMALE: OK. That is good to hear.
UNIDENTIFIED MALE: You're listening to KNDC 490 AM, 106.7 FM in Hettinger, North Dakota.
DR. CATHY HOULE, FAMILY PHYSICIAN: I'm going to retire in about two years. I'm concerned about somebody coming in to fill my shoes. I don't know if they're going to find someone to fill the job.
All rural areas are experiencing population loss. Increasingly, it's difficult to recruit and retain people to work in the medical field. And it got worse after COVID. Hettinger itself is about 1100 people. We're 70 miles from Montana and four miles from South Dakota. But the service area that we cover at the hospital is about 20,000 square miles. We serve 20,000 people over a large area.
If this hospital goes away, the nearest hospital that does anything like what we do is 70 miles from here, and we already have people driving 90 miles to get here. Everybody wears multiple hats. The CEO drove the ambulance. It's hard to recruit people because there's a lot of education required to be an EMT. Hi, Paul. I'm Dr. Houle. What happened today? Did you get lightheaded?
Did you have chest pains? Shortness of breath? What happened?
[20:05:02]
ALYSON KORNELE, HOSPITAL CEO: I've been doing ambulance runs for about three years now. Just as a driver.
He has emphysema and asthma, too.
Help get people from here to there.
HOULE: Did you happen to get a 12 lead?
KORNELE: We have over 40 positions open right now.
This is my office.
With around 200 current employees.
This used to be a full lobby.
This job has probably been open for about 10 years, 2016.
LAVANDERA: This has been a beautiful drive into Hettinger, North Dakota. Driving south. The views are just majestic. The wide open plains. The landscape is really just stunning.
How do you pronounce the name of the town?
KORNELE: Hettinger.
LAVANDERA: Hettinger. Check out the map.
KORNELE: Just right up here in the corner, you can see where.
LAVANDERA: Right where the cluster is. All right. Do you feel like you're in the middle of nowhere?
KORNELE: A little bit, and it's nice. That's the goal. Yes.
(LAUGHTER)
LAVANDERA: You guys serve a lot of this area like --
KORNELE: Absolutely.
LAVANDERA: Like even into South Dakota too?
KORNELE: Yes. We pull all the way from Montana as well.
LAVANDERA: So this little hospital.
KORNELE: Serves three states.
LAVANDERA: Three states. What are the challenges you face running a small hospital in a small town?
KORNELE: We have the resources to get the materials, the tools. We just don't have the workforce.
UNIDENTIFIED FEMALE: Hettinger Hospital, how can I help you?
UNIDENTIFIED FEMALE: We have a lady coming in by ambulance. She was found unresponsive at home.
HOULE: What is our baseline for this?
UNIDENTIFIED FEMALE: No response, ma'am. No response.
HOULE: We'll probably just admit her and keep her comfortable and let her pass. They called their priest in.
Father Adam is here.
LAVANDERA: The demographics of the patients that you're dealing with, Census information shows that Hettinger is 90 percent white.
HOULE: When I came here, it was probably 98 percent white.
UNIDENTIFIED MALE: It's not much of a cut.
HOULE: We have a very large elderly population.
I think it's deep and every time you use your hand, it's going to open up. I might put one inside just to pull that deep tissue together.
We have a large agricultural population. So farmers, ranchers.
Well, it's a good thing your doctor had you do that to us, huh?
Fewer younger people. But they are here.
Knock, knock, knock. Hello?
UNIDENTIFIED FEMALE: Hey.
HOULE: Hi, Lynn. What's going on?
LAVANDERA: How sustainable is a hospital like this?
UNIDENTIFIED FEMALE: Back pain here.
HOULE: Take some breaths in and out.
It's a struggle because of recruitment.
Does that hurt?
UNIDENTIFIED FEMALE: Oh, that hurts.
HOULE: We're a long way from everywhere. And we need to be able to do what we can. UNIDENTIFIED FEMALE: Busy day today.
HOULE: Yes. It's Sunday of a holiday weekend. OK, I'm up on top. Now we're going to go to Dr. Roger Schauer's funeral. So. What shoes to put on?
Dr. Schauer came here right out of his residency, I believe. He was a big part of this place for a lot of years. He really was an advocate for rural health care. All right. This is going to be a big one, I think.
Hi. How are you? I haven't seen you guys forever. I got to sit on the aisle because I'm on call right now. But maybe I'll just sit over on the side there behind Jerry.
(SINGING)
[20:10:00]
HOULE: They're getting slammed so I'm going to go home and change clothes and head back to work.
Here we go.
UNIDENTIFIED FEMALE: How am I holding up? Not well. I am doing well.
HOULE: Tasha is talking to the nursing home and just letting them know.
Right now, it's 7:45 at night. I'm on call until Tuesday morning at 8:00. About another 36 hours.
How are you? All right. Barbed wire?
UNIDENTIFIED MALE: Yes, they were pulling the barbed wire off, there was eight or nine rolls that were vertically, part of it just dropped here.
HOULE: It shouldn't matter who retires but it's harder and harder to find people to fill the gaps. There just are fewer and fewer people willing to come out here and do this kind of medicine.
URSULA AGUEDAN, O.R. NURSE: Today is busy. I am hired as an awareness.
UNIDENTIFIED FEMALE: OK, so let's go (INAUDIBLE) gets over here so we can have another hand.
AGUEDAN: There is only one person that works in the E.R..
UNIDENTIFIED FEMALE: You want to come over here, Ursula?
AGUEDAN: So I need to kind of step in and help.
UNIDENTIFIED MALE: OK. I'm going to lift your head a little.
AGUEDAN: And I'm still on call in the O.R.. UNIDENTIFIED MALE: Your blood sugar is normally in the 250s. I got her
at 326.
AGUEDAN: Just going to put this in one of your finger. OK?
LAVANDERA: How does your hometown in the Philippines compare to Hettinger?
AGUEDAN: I would say it's almost the same, minus the rivers and the coconut trees.
GINGER PARALLAG, MEDICAL TECHNOLOGIST: Today I was at home preparing lunch. Then they called me and they said, I have a patient for blood extraction in E.R. Two. I am from the Philippines. I grew up in a town something similar like this. It's like I never left home.
LAVANDERA: The immigrant workforce that's coming in, how vital are they to keeping this place running?
AGUEDAN: Keep squeezing my hand if you feel any discomfort.
HOULE: That's becoming a bigger part of our survival.
PARALLAG: It's going to move. It's good now slowly.
HOULE: This week Thursday, we have someone coming in to interview for an internal medicine position.
AGUEDAN: It's always like this towards the end of the shift. That's when you get very busy. I'll be working tomorrow, so I'll leave my chips. Thank you so much.
UNIDENTIFIED FEMALE: All right, Pat, we're going to --
BEKKI HOLZKAMM, LAB MANAGER: I did a deep dive into how many applications that I've gotten. 31 applications from the Philippines, 11 applicants from Nigeria, three applicants from Ghana.
(COMMERCIAL BREAK)
[20:15:24]
UNIDENTIFIED FEMALE: All right, Par, we're going to go in head first.
UNIDENTIFIED MALE: Pat is an 80-year-old male.
UNIDENTIFIED FEMALE: One, two, three.
UNIDENTIFIED MALE: He's coming in for some chest pain.
You're pretty high risk for having a heart attack right now. And it may be developing.
UNIDENTIFIED MALE: All right, sir. Take a big breath in. We're going to do some blood work.
LAVANDERA: How important is this hospital to you?
KAREN ODENBACH, PAT'S WIFE: It's very important. It's the closest one we have. There's just all small towns around us.
PARALLAG: I ran the blood samples for the E.R. patient. This is a hematology machine.
UNIDENTIFIED MALE: How long have you worked here?
PARALLAG: Since 2022. So four years now. We're all Filipinos here.
HOLZKAMM: The immigration pipeline is really the most viable way for me to have an appropriate candidate to work here.
We have had a job opening in the lab since we posted it in late August of 2025. I did a deep dive into how many applications that I've gotten. We received 31 applications directly online from the Philippines. All of them were very well-qualified. We had 11 applicants from Nigeria. We had three applicants that were direct from Ghana. We had two very viable candidates. They were both American.
We offered job offers to both of them, they both declined the job offers. Essentially, it was due to the fact that we're very rural.
LAVANDERA: When you look at your staffing, you're filling the jobs for, let's say, the most critical, are immigrants the only people applying for those jobs here?
KORNELE: Yes. The immigrant workforce is a very critical piece of the tools we utilize to stay open.
PARALLAG: When I'm working until 5:00, first thing to do is get Chloe at daycare.
What did you learn at school today?
UNIDENTIFIED FEMALE: Two.
PARALLAG: Number two.
LAVANDERA: You learned to do what you do in the Philippines.
PARALLAG: It's a four year course in college.
LAVANDERA: Why did you have to leave the Philippines to do what you're doing?
PARALLAG: It's because of the salary.
UNIDENTIFIED FEMALE: What, Mighty Dragon, please --
PARALLAG: I can't raise my kids with that amount of money.
MARICHU VILLAMIEL, ULTRASOUND TECHNOLOGIST: Yes? You want? Tomorrow we're just going to go to daycare and on Friday, too. Go take shower. Are you excited for your first day of school? Yes, OK. What time is it? We'll have our breakfast.
I grew up in Manila. The capital of The Philippines. My partner Eric and I came here together, and then the children six months ago.
This one.
UNIDENTIFIED FEMALE: I'm going to kill you.
LAVANDERA: So they're --
VILLAMIEL: Yes. Very new.
LAVANDERA: They're still new here.
VILLAMIEL: Yes.
UNIDENTIFIED MALE: Maybe you should stay home.
VILLAMIEL: Not allowed, right?
UNIDENTIFIED MALE: No, you can't. Just turn it on.
LAVANDERA: Why did you want to come to the United States to work?
VILLAMIEL: This is my dream.
UNIDENTIFIED MALE: How was it dropping the kids off today and then going to work, Marichu?
VILLAMIEL: That's OK. It's a great day always. Amazing day.
UNIDENTIFIED MALE: It's a quiet day. Bye.
VILLAMIEL: Bye.
JODI BURNS, RADIOLOGY MANAGER: For Marichu's position --
VILLAMIEL: Are you fasting?
UNIDENTIFIED MALE: Yes.
BURNS: We only had about three applicants from 2022 to 2024. Two of them were from the United States.
VILLAMIEL: Did you drink water?
UNIDENTIFIED FEMALE: Yes.
BURNS: One of them was interested in the position.
[20:20:00]
VILLAMIEL: Let's see if we can find it.
BURNS: He decided to go into a different position elsewhere.
UNIDENTIFIED FEMALE: I also want a boy.
VILLAMIEL: Boy? OK, let's see.
BURNS: The other person was not qualified. Marichu was only like the third applicant.
VILLAMIEL: It's a girl. Yes. This is a girl appearance.
BURNS: The opportunity that they're getting from coming here and filling the need that we have.
UNIDENTIFIED FEMALE: I got two sisters.
BURNS: She's always so grateful about everything.
VILLAMIEL: When is your appointment with doctor?
UNIDENTIFIED FEMALE: I don't know. I have to schedule it.
VILLAMIEL: OK.
LEONA FREYMILLER, SURGERY PATIENT: We were both born and raised here.
LAVANDERA: You bought this land when you were 18 years old?
UNIDENTIFIED MALE: Yes. Didn't cost much. But it took a long time to pay for it.
LAVANDERA: When you live out in such a rural location, the way you guys live.
FREYMILLER: This is a picture right before our 50th wedding anniversary. Our own wedding.
LAVANDERA: Does it give you peace of mind knowing that that hospital is close by?
FREYMILLER: Yes. We had a little boy just up the road here. Got kicked by a horse in the head. One guy jumped off his combine, broke his leg. You just need it.
When we were having our kids, that's where we went. If we would have went to Bowman, our boys probably wouldn't have made it because they were born early.
LAVANDERA: What do you mean wouldn't have made it, like --
FREYMILLER: They would have died.
LAVANDERA: And when your children were born, was it more American born employees there in the hospital or you've seen that -- you've seen that change?
FREYMILLER: Yes. The change, yes. Throughout the years. People don't want to come out here and work. They want to stay in the big cities.
LAVANDERA: You were in the hospital recently?
FREYMILLER: Yes. I had my gallbladder out.
UNIDENTIFIED FEMALE: Morning.
UNIDENTIFIED FEMALE: We got Miss Leona at 8:41.
MELISSA LUMBAO, REGISTERED NURSE: Dina, can I have another blade 11?
Since I was in college, my plan was to go in the -- here in the U.S..
LAVANDERA: Did you feel like coming to the United States was an opportunity to make your life better?
AGUEDAN: Oh, yes, 100 percent.
LAVANDERA: In what way?
AGUEDAN: Many things. So money, time, opportunities.
DORIS HOKE, SURGERY MANAGER: Before Ursula came and Melissa came, the positions were open for at least three and a half years. No one was applying.
AGUEDAN: We just took out a gallbladder and we will be waking the patient up now.
I'll hold your hand because we don't want you to scratch your eyes.
FREYMILLER: I don't know what the gal's name was that woke me up.
AGUEDAN: She's still in la, la, land. Leona.
FREYMILLER: She said, wake up now. You're going back to sleep again.
AGUEDAN: Your surgery is done. We're just waiting for you to wake up.
LAVANDERA: Why did you want to work in the medical field?
AGUEDAN: Yes. You're in recovery room.
I like helping people. It's like self-fulfillment for me when I share the knowledge to someone. And I know it will be helpful for them.
FREYMILLER: We had twin boys 49 years ago in here.
AGUEDAN: I don't have any plans on going back to our country. At this moment it felt like a little bit hopeless to go back.
LAVANDERA: Do you want to become a U.S. citizen? Do you want to get a --
AGUEDAN: If I would get the opportunity, why not? Yes.
LAVANDERA: There are a lot of people who say that there are immigrants who come to this country, and they take jobs from Americans. Do you ever hear that or do you ever think about that?
AGUEDAN: Can't we live side by side without taking anything?
LAVANDERA: How grateful are you to these immigrants who are coming and working here?
FREYMILLER: We need them. That's all I can say is we need them.
LAVANDERA: Do you feel like that is a sentiment that is shared by everyone who lives within the area?
FREYMILLER: Not necessarily. There are some people that are still kind of, don't think they should be here.
LAVANDERA: Really, you hear that?
FREYMILLER: Oh, yes.
LAVANDERA: Wow. When you hear people say what you're talking about, do you tell them anything or?
FREYMILLER: Oh, yes. It's like what -- you know, they're doing their job. Be grateful you have them. Otherwise you won't even be alive maybe even without those people helping.
LAVANDERA: One of the reasons why we're here in Hettinger actually has to do with something that I've been reporting on over the course of the last year.
[20:25:04]
In Texas, there's been this tension that has emerged in the Dallas suburbs. This is a city council meeting.
UNIDENTIFIED MALE: Most of these people are probably retired and don't understand how H1-B is taking jobs from American citizens.
UNIDENTIFIED FEMALE: We need to bring back the American worker, support our American doctors, instead of just giving our country away.
LAVANDERA: This is a protest, and it's really like one of the most openly racist things I've seen in quite some time.
PROTESTERS: You will not replace us. You will not replace us.
LAVANDERA: It has echoes of what we heard in Charlottesville a few years ago. A lot of this fight is centered around the number of immigrants who have come to the region on H-1B visas. That's why it's important to be here in a place like Hettinger.
STATE REP. KEITH KEMPENICH (R-ND): They come from a country that's broken and they want to bring that culture here? That's not us.
(COMMERCIAL BREAK)
[20:30:48] UNIDENTIFIED MALE: I was born in that hospital.
LAVANDERA: You get like all these immigrant workers who are coming here.
UNIDENTIFIED MALE: Which is fine, whatever. But we just need people to fill the positions in our hospital.
LAVANDERA: Were you born there in the hospital, too?
UNIDENTIFIED MALE: Yes. It's bringing diversity to town, and they're pretty good, honest people. So it ain't like we're getting flooded.
LAVANDERA: The evolution you've seen take place here in Hettinger has been -- you welcome it with open arms, it sounds like.
UNIDENTIFIED MALE: Well, I mean, change is always a challenge, right? But if we can't keep our hospital open, this town is nothing.
LAVANDERA: We are on our way now to interview Republican State Representative Keith Koepnick. For more than 30 years, he's represented this southwest corner of North Dakota. He co-sponsored a bill that would have eliminated the Office of Legal Immigration. It is a state agency that was helping places like the hospital here in Hettinger find workers.
Your issue with the Office of Legal Immigration was what?
KEMPENICH: Well, it was -- I think there's a lot of duplication in some of the stuff that's already going on because we don't -- we don't provide the visas.
LAVANDERA: Did your sponsoring of that bill kind of get interpreted as making you someone who was against legal immigration?
KEMPENICH: Well, it is, and you kind of look at the sponsor, the person that sponsored it was probably.
LAVANDERA: But that was --
KEMPENICH: He was referring what you just said was that we were -- we should focus on local employment instead of trying to do it with immigration. And I didn't -- that wasn't -- that wasn't probably my take on why I was doing it.
LAVANDERA: Do you regret signing on to it?
KEMPENICH: Well, it doesn't matter. It didn't pass.
LAVANDERA: When you look at the workforce that's needed to keep the hospital here in Hettinger working, it needs immigrant labor.
KEMPENICH: It needs help. I mean, you need to get -- you need to fill the positions. You know, you can't -- yes, it doesn't do any good to have a hospital or anything else. And you can't fill the positions on it, but you need qualified -- like a lot of these, when you get into the professional end of things, I think they have the skillset. It's probably the communication set, you know?
LAVANDERA: You're talking about like a language barrier with immigrants?
KEMPENICH: Yes, language and understanding what you're saying and what I'm saying.
LAVANDERA: Have you heard, in specifically about the hospital, have you heard that that communication, those language barriers have been an issue at all?
KEMPENICH: Well, it's a concern. It is.
LAVANDERA: Overall, the amount of immigrant labor that needs to be brought in, do you support that or does it cause you concern?
KEMPENICH: Well, you can harm people if you don't -- you know, if there's miscommunication of what you're trying to do or what the intent is and stuff on it. And I think the assimilation is getting to be kind of a question in a lot of areas.
LAVANDERA: In what way?
KEMPENICH: Well, are you assimilating into this country, or do you want to keep your old country? You know, if you do, why don't you go back there?
LAVANDERA: So you're supportive of legal immigration, the immigrant workforce that's coming into Hettinger?
KEMPENICH: Yes, yes. We're all immigrants. I may be an illegal, I don't know. They lost track of me here or our name back in 1820 something.
LAVANDERA: But the two things you keep coming back to are the assimilation of the immigrants and the language.
KEMPENICH: Yes. Yes. Yes, yes, yes, yes, yes. Because if you want to -- if you want to work here, but you don't want to assimilate, then go back to your own country and fix it. You come from a country that's broken and I'm going to say broken, there's probably worse than that. And then want to bring that culture here? That's not us.
VILLAMIEL: Relax. OK.
All the patients that I have.
OK. You OK?
I'm taking care from the heart. From the heart.
Check this one. This area. OK? The tummy area.
LAVANDERA: Do you want to stay here forever? Do you see yourself anywhere else?
[20:35:01]
VILLAMIEL: I love the place.
What else do you need? You want me to put the pillow in your legs? I can leave now. OK? You OK? OK.
LAVANDERA: You're happy?
VILLAMIEL: Yes. I'm happy.
LAVANDERA: You seem like you get a little emotional about it.
VILLAMIEL: Yes. Because.
Check your bag.
Hettinger is a home. There's people around here that they are not complaining with the life here. So, meaning they have no stress.
LAVANDERA: People sometimes will say immigrants like you need to assimilate. Do you ever feel like you have to leave part of your Filipino side, your culture behind?
VILLAMIEL: I can be both, but still, of course, my heart and my blood runs as a Filipino.
UNIDENTIFIED FEMALE: Do you ever have issues with miscommunication?
KORNELE: No, not at all. I know they all passed an English test.
LAVANDERA: If you don't have the immigrant workers that you're able to bring in legally to work here, what happens?
UNIDENTIFIED MALE: We're going to draw your blood again.
KORNELE: I wouldn't have a laboratory department. I wouldn't be able to take you back for surgery. We wouldn't be able to deliver babies. I wouldn't have enough staff.
LAVANDERA: The hospital would be left a shell of itself.
UNIDENTIFIED REPORTER: The Trump administration's new H-1B visa crackdown.
UNIDENTIFIED REPORTER: Major changes are coming to how the U.S. handles visas for foreign workers.
UNIDENTIFIED REPORTER: They've also been targeting other legal immigration routes.
UNIDENTIFIED REPORTER: Trump says he's trying to protect American workers.
LAVANDERA: There has been so much focus on undocumented immigrants. But there's a shift happening. People who have come to the U.S. through legal pathways are now facing backlash. UNIDENTIFIED REPORTER: President Trump signed an executive action. His
plan could worsen an existing physician shortage.
(COMMERCIAL BREAK)
[20:41:52]
REP. RILEY MOORE (R-WV): What I would like to see is the H-1B visa program completely ended. It's a scam on the American people. All this is about is cheap foreign labor and replacing the American worker.
REP. BERTH VAN DUYNE (R-TX): We are seeing American jobs that could be filled with American workers that are being given to H-1B visa holders.
LAVANDERA: You've probably heard a lot of debate around H-1B visas lately. This is main street in Hettinger. That's the only grocery store in town. It's what is technically known as a nonimmigrant visa, but it gives temporary work permission for highly trained, highly skilled workers. There's the Pastime Bar Steakhouse, four generations or more. I think they've owned this place. There's no question that a lot of the people who get these visas and they come here, you know, they envision something greater for themselves. They want to eventually get legal immigrant status.
You're here on an H-1B visa?
VILLAMIEL: Yes.
UNIDENTIFIED FEMALE: Done?
VILLAMIEL: Done.
UNIDENTIFIED FEMALE: Thank goodness.
LAVANDERA: You'd like to get a green card?
VILLAMIEL: Yes. For my children. This is for my children's future as well.
LAVANDERA: You're here on an H-1B visa?
PARALLAG: Yes.
LAVANDERA: And how long does that last for?
PARALLAG: Three years first. And then you can renew it for another three years.
AGUEDAN: Administration of anesthesia.
I was hired through H-1B.
While she's in there, she'll take snaps.
That visa expired last January this year. It was renewed. Just keep this. Yes.
LUMBAO: I got here five months after the approval of the H-1B visa. A lot of my friends are still in the Philippines waiting for their visa. Some of them waited for three years now. Some of them are like giving up.
LAVANDERA: What are some of the challenges in bringing immigrant workers here?
KORNELE: The hardest part here recently was the $100,000 fee. We had multiple nurses and potential employees within the pipeline that just had to stop and wait and have been waiting for over a year now.
HOLZKAMM: Welcome to the laboratory.
Even the recruiters that would help us paused from sending us applications.
LAVANDERA: How many workers do you have on H-1B visas now?
KORNELE: Close to 20.
LAVANDERA: That would be 20 times $100,000. That's $2 million? What would that do to your bottom line?
KORNELE: Oh, I wouldn't even want to think about that. It's just something that we know isn't feasible. We'd have to rely on travel staff, but financially, that's not a long term solution.
UNIDENTIFIED REPORTER: Hospitals across the country are in need of travel nurses who work on temporary contracts for higher fees.
[20:45:00]
KORNELE: If you guys want to like use my numbers and make a prettier graph, then go for it.
With a contract travel nurse over three years, we'd be paying over $700,000 in cost. If we had a full time H-1B nurse, it would be just over 200,000. And so there's about a $500,000 difference over three years.
LAVANDERA: In 2025, when the Trump administration proposed this $100,000 fee on the H-1B visa, a federal judge struck that down. But now, in August of 2026, the Trump administration is trying again, this time proposing an even larger fee of $103,000.
WOLF BLITZER, CNN ANCHOR: The Trump administration is proposing a massive new price tag for the popular H-1B worker visa.
UNIDENTIFIED FEMALE: One of the concerns early on, at least with the last hike, was for hospitals and universities. Today this time around they're going to be exempt.
KORNELE: We just found out yesterday it would not directly affect us. It really would affect the public sector. Since we're a nonprofit, we are not subject to the capped H-1B visas. And so this specific fee for the $103,000 is just for the capped. Thank goodness.
The hardest part about all of it is it's changing every day. We get e- mails from our lawyers almost daily. We never know what's going to happen.
VILLAMIEL: I'm so happy that we're here in the United States of America. I never dreamed of this. I'm going to cry. No, I don't want to cry.
HOULE: That was a very difficult, long labor.
OK, you're breathing now. You're OK. You're working hard.
LAVANDERA: Do you feel like the people who lived here accepted you?
(COMMERCIAL BREAK)
[20:51:12]
GRAPHICS: While filming in Hettinger, three new elementary school teachers arrived.
DARIN SEAMANDS, HETTINGER PUBLIC SCHOOL SUPERINTENDENT: Here we are.
JOAN MALLARI, KINDERGARTEN TEACHER: It's a long ride.
UNIDENTIFIED FEMALE: Hi. Welcome.
LEAH MAE BAUYOT, FIRST GRADE TEACHER: Oh, hi. Thank you.
SEAMANDS: We had to go out to fill some positions.
BAUYOT: I put my clothes here.
SEAMANDS: And actually get serious about bringing in teachers from the Philippines.
ZAIRA CHINTE, SECOND GRADE TEACHER: Finally, we're here.
LAVANDERA: That's never happened.
SEAMANDS: That has never happened here in Hettinger.
MALLARI: We're happy. Excited to meet our kids.
CHINTE: Overwhelming.
UNIDENTIFIED FEMALE: Overwhelming?
CHINTE: Yes. Overwhelming.
LAVANDERA: When you would post a job for a teacher opening, how many applicants are you getting? SEAMANDS: So over the last two decades, it's really gotten down to, if
you can get two or three, it's amazing. I'll be honest, in some situations you're lucky to get one.
MALLARI: Welcome to North Dakota. I'm so very happy that we're finally here. Tomorrow when I woke up, I'm going to drink my coffee and, hello, Hettinger.
BAUYOT: We're so happy that we're here in the United States of America. I never dreamed of this. And --
MALLARI: We want to kiss the floor. In the airport.
UNIDENTIFIED FEMALE: Nice to meet you, guys. I'm so excited. Are you excited?
BAUYOT: Yes. I might cry. No, I don't want to cry.
MALLARI: Of the United States of America.
BAUYOT: Get your crayons. Get your crayons. Oh, it's hard. OK. Maybe I can help.
CHINTE: Seven, eight, nine, 10. OK, you do it. I know you can do it.
MALLARI: Now we have our months of the year. September, October, November.
CHINTE: One of my students asked me, thank you for coming here. You left your daughter in the Philippines just for us. It's four plus two, what's the answer?
I'm so touched with that because they see -- they see our effort as a teacher coming here. So, yes, that's it. Sorry.
Leaving my daughter in the Philippines, it's our first time long distance. After a week when I arrived here, she became sick, a fever. My mother told me she keeps on missing me, that's why.
UNIDENTIFIED FEMALE: How are the students?
BAUYOT: It's just a matter of classroom management. And eventually I will get their attention. I will get their heart. Just build positive relationships throughout the year and it will be good. I know it will. God will.
UNIDENTIFIED FEMALE: And what do you miss most about home?
BAUYOT: Oh, back home. I'm crying. My daughter, my son and my husband, food.
MALLARI: This is me and my son. It's the first time that I will not be with him. I'm doing this for our future.
VILLAMIEL: Hello. Let's go. We'll check the baby's movement.
GRAPHICS: Hettinger, like many rural cities around the country, faces a rapidly declining population.
VILLAMIEL: You are now 32 weeks and six days.
GRAPHICS: Over the past two decades, immigrants have been helping repopulate rural America, according to researcher analyzing U.S. Census data.
VILLAMIEL: Coming so soon. It's coming soon. Yes.
MAYRA VERDIN, PATIENT: I'm from Mexico. From Aguascalientes.
HUGO VERDIN, MAYRA'S HUSBAND: I'm from Jalisco.
[20:55:02]
VILLAMIEL: The head is here down.
M. VERDIN: He's down now?
VILLAMIEL: Yes.
M. VERDIN: OK.
LAVANDERA: When you first moved to Hettinger 15 years ago.
VILLAMIEL: See the movement?
LAVANDERA: Do you feel like the people who lived here accepted you?
M. VERDIN: I think they want us. You know? But it was more political.
VILLAMIEL: Everything looks good. Nothing to worry.
M. VERDIN: OK, that is good to hear.
VILLAMIEL: OK. Thank you. There you go.
M. VERDIN: Children, before they say, I don't know what language do you speak? You're speaking Chinese or what? No, I'm speaking Spanish. Oh, you know, because there are some people, they don't go out, only here.
LAVANDERA: And now, how many languages do you hear in Hettinger?
M. VERDIN: Oh, there are many.
H. VERDIN: So Mayra is in the hospital now. So can you guys bring to the hospital?
HOULE: That was a very difficult long labor.
You've been pushing for two hours now. And you know, I'm sure you're getting tired.
Give her a whole list here. I'll go grab you another bag.
If the pushing isn't bringing the baby down and we can't get it to come down another way, then a C-section is our other option.
(CROSSTALK)
UNIDENTIFIED FEMALE: Push. You got this. You can do it. Stay with it. Stay with it. It is OK to cry.
HOULE: You've been pushing about two and a half hours. OK, OK.
UNIDENTIFIED FEMALE: Slow your breathing down. You're OK. You're working hard. OK.
HOULE: Every delivery is so different. So different.
UNIDENTIFIED FEMALE: This is the wildest one for you, isn't it?
HOULE: Go, go, go. Push, push, push. You got it, you got it, you got it.
(CROSSTALK)
UNIDENTIFIED FEMALE: I got him. If you want to clamp and cut. Hi, bud. Hi. That's surprising, isn't it?
(CROSSTALK)
UNIDENTIFIED FEMALE: Good job, buddy. He's still going to come visit me for just a minute. OK. Congratulations, mama.
HOULE: OK, there we go.
It's really, really a privilege to be part of that with a family. Especially with the family that's nice and welcoming as they are. They are really an integral part of our community.
LAVANDERA: You can see your family growing old here?
H. VERDIN: Yes. The first time I asked her. What happened if I die one day, and she said, oh, send me to Phoenix, Arizona, because all the families there. Now, what do you think? Hettinger.
LAVANDERA: So this feels like home.
H. VERDIN: Yes. Feels like home.
LAVANDERA: Now we're interrupting?
KORNELE: No. You're good.
LAVANDERA: There was supposed to be a doctor from Nigeria coming to interview for a position here on the last day that we were here.
KORNELE: Yes.
LAVANDERA: And what happened?
KORNELE: I got a message two days prior from the recruiter that said she had found another role and was looking to accept that.
LAVANDERA: Do you have other names on the list that you can go to, or you're really just starting from scratch?
KORNELE: We are starting from scratch. Yes. We've had this position open for several years now.
UNIDENTIFIED FEMALE: All right, let's get some fluids started.
Today we've had a couple of ambulances tonight.
UNIDENTIFIED FEMALE: Tonight when he got home he was vomiting.
UNIDENTIFIED MALE: We had her on a non-rebreather.
HOULE: Yesterday was pretty busy. So we're going to grab a little bit of lab work from you.
I'm at about 60 hours of my 72-hour call.
You want to grab the bladder scan?
LAVANDERA: Do you feel like we've gotten a pretty good grasp of what you guys deal with and the challenges you guys face?
HOULE: I hope so.
You have no idea what this hand has been through.
People live here, too. They need care here.
There we go. OK. All right. I'll be back shortly.
UNIDENTIFIED FEMALE: I'm not going anywhere.
HOULE: OK.
UNIDENTIFIED FEMALE: Thank you, thank you.
HOULE: Yes. Just a little bit.
GRAPHIC: According to a 2026 analysis, more than 40 percent of rural hospitals are operating at a loss in the U.S. 417 are at risk of closing.
(END VIDEOTAPE)
