The idea of requiring a high salary is reasonable, but I'd make it rather e.g. 120% of the median salary in a particular industry.
If you can't find somebody skilled enough here to work for 200k or less, then you should probably be paying 200k or more since you're looking for a role that is niche and low supply.
This fee is a great way to ensure that there's very little medical services available to rural populations and to help kill science in the US among other things.
Rural hospitals are lucky to have any doctor on staff let alone a cardiologist. They are mostly staffed by nurses for quick patch-up work and life flights to major medical centers.
H1B doesn't solve the problem of poor communities getting poor healthcare. Frankly, it costs too much to become a doctor which limits where doctors can be employed. Plenty would like to work rural, but not with $500,000 in student loans. And no, that's no joke. I have a nephew going to medical school in Idaho and that's what his loans are.
A serious problem should not be treated with a band-aid and if you think a band-aid is ok do not be surprised the problem gets worse.