<p>Over the past several decades, high-skilled immigrants have made substantial contributions to the scientific, technological, and economic advancement of the United States. Immigrants employed in STEM (science, technology, engineering, and mathematics) occupations have been particularly instrumental in sustaining the nation’s global leadership in innovation and research. Nevertheless, despite the increasing integration of global labor markets, public attitudes toward high-skilled immigration have oscillated between expansionary and restrictive positions. Concurrently, enduring structural deficiencies within the U.S. immigration system have rendered pathways to work authorization and permanent residency for prospective STEM immigrants both uncertain and inefficient. Although policy debates surrounding immigration reform for high-skilled and STEM workers have remained persistent and contentious, comprehensive legislative action has been hampered by entrenched interests and divisions among stakeholders. This article examines the principal challenges and barriers encountered by foreign-born high-skilled STEM professionals across distinct phases and categories of the U.S. immigration process. It further synthesizes prevailing perspectives on major reform proposals and policy frameworks, offering a critical assessment of their implications. The study concludes with recommendations for restructuring the immigration system to enhance its efficiency, equity, and capacity to advance both national innovation objectives and the professional aspirations of STEM immigrants.</p>