Conrad State 30 J-1 visa waiver programs (commonly called Conrad 30 programs) allow international medical graduates (IMGs) training in the U.S. on J-1 visas to remain in the U.S. after completing residency to provide healthcare for rural and urban medically underserved populations. This study collected information from state health department personnel, using both quantitative and qualitative methods, to characterize national trends in waivers and factors related to states' successful recruitment of IMGs for the years 2000-01 through 2009-10. States varied greatly in the number of waivers used and in the resources devoted to operating the Conrad 30 program. Over the decade there was a shift away from rural primary care placements of IMGs toward non-rural specialist placements. States with larger populations gained an increasing share of J-1 visa waiver physicians during the decade of the 2000s. States devoting more staff to the Conrad 30 program recruited more physicians seeking waivers. Whether or not states charged applicant fees had no association with the number of waivers used.