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Does that mean Americans don't want to work in American heartland and south as nurses and civil engineers?

Or does that mean American heartland and South don't want to pay competitive wages?

We have a supply of domestic nurses that travel to these areas. Why do they need foreign visas? Maybe I'm misunderstanding what the Dutch Auction is.

This is a good point. How about a per state auction instead? Where each state gets an allocation based on its population.

And what is wrong with that? And are there no "nurses, civil engineers or anyone else for that matter" in the heartland?? How do they even survive??