Applicants for legal permanent residency in the United States are required to pass a medical screening. Most of these applicants are already living in the United States on non-immigrant and temporary visas and are screened by civil surgeons, physicians designated by the government to look for infectious diseases, incomplete immunization records, and signs that the immigrant will pose a threat or become a public charge. Little is known about the work of these 4000+ physicians, who play a key role as migration brokers in a context where migration control has devolved to non-state actors. I present quantitative analysis of a random survey of civil surgeons, identifying features of this migration industry and constructing at typology of profit seekers, immigrant advocates, and screeners. Most civil surgeons are in the private sector, dominated by immigrant doctors who tend to pass most applicants and charge higher fees. A smaller subset are in the public sector, dominated by US born doctors who pass fewer applicants and charge lower fees. These patterns exacerbate inequalities among immigrants. I consider theoretical implications for literatures on migration industries and brokerage, co-ethnic economies, and street-level bureaucrats, as well as the implications of the US case for global migration management.