I think one easy thing to do to ensure that small cos and rural areas still have access is to require all h1b hires to be level 4, the highest level. As it stands now more than 70% are hired at levels 1 and 2 (2018 data), which are essentially "below average" which is weird for a program aimed at bringing in those with hard to find skills.
H1B doesn't really have a job market test. You just need to justify it's a job that requires a bachelor's degree and pays whatever the DOL wage data says should be the prevailing wage for that classification. It's not that difficult to game the system by playing around with job level, title and location and getting away with the lowest possible pay. This is basically the business model of staffing agencies and contractors.
It's also being used by many genuine employers looking for talent and highly specialized skills. Cost isn't a concern here as their business model relies on making the best product.
> The H 1B also requires that the H-1B employer pay the H-1B employee the prevailing wage or the actual wage, whichever is higher.
And https://www.dol.gov/whd/h1bworkers.htm
> and you must be offered fringe benefits on the same basis as offered to U.S. employees.
But now that I read it again, they may be separate things that don't sum up. Is that what you meant?