Here's how it works in practice: You create a job posting that's buried on your careers page and has so many very specific requirements for an underleveled role (because it's custom-made for the H1B person you want to hire) that no local worker can possibly meet them all. Then you half-heartedly phone screen a few people to check the box before throwing up your hands and saying, "We tried and weren't able to find any local workers; we have no choice but to hire an H1B!"

This could all be fixed by making H1B visas an auction system, but all the H1B legislation changes I've seen have been half-hearted at best.