The 10 Hardest Jobs to Fill in the US

Appcast's Recruiting Difficulty Score reveals which roles recruiters struggle the most to fill — and why healthcare dominates the top 10.

Photo credit: Andriy Blokhin

Have you ever wondered what the hardest-to-fill jobs are in the U.S.? Well, lucky for you, we have the answer!

To create this ranking, we use Appcast’s proprietary Recruiting Difficulty Score (RDS) developed by Sam Kuhn. The metric is designed to measure how challenging it is for employers to hire for a given occupation. For that purpose, it is not enough to simply look at the jobs with the largest worker shortages. Instead, we focus on occupations with the highest ratio of active job postings to total employment — a measure of demand relative to the size of the available workforce. Our metric also considers median posting duration, which shows how long a job advertisement remains active. Occupations with exceptionally high hiring needs relative to candidate supply, combined with elevated time-to-hire, receive the highest RDS.

1. Special education teachers

Contrary to what many would predict to be the hardest occupation to fill in the U.S., it is special education teachers who take the No.1 spot. Despite earning comparable pay to their general education peers (about $65,000 per year), special education teachers face significantly greater demands on the job. Another issue is that fewer people are entering the field, while the number of students who require special education services continues to increase. In March 2024, 51% of public schools nationwide reported that they would need to fill positions in special education. All these factors leave candidate supply short of demand in today’s labor market.

2. Counselors

The first of many healthcare occupations on this list, counselors are extremely hard to hire in today’s labor market. Becoming a licensed counselor in the U.S. requires a long process. Candidates must earn bachelor’s and master’s degrees, accumulate 2,000 to 4,500 hours of supervised clinical experience depending on the state, then pass a licensing exam. All told, that puts most counselors in the job market roughly eight to nine years after starting college. A broader pipeline of candidates, along with a slightly more stable and less demanding day-to-day, is what keeps this occupation just below special education teachers.

3. Dentists

Like counseling, dentistry requires eight years of schooling before a candidate reaches the job market. This, along with an aging U.S. population, means demand is rising faster than supply can keep up. Being a dentist also means missing out on the remote or hybrid perks many of their peers enjoy. You can’t do a root canal over Zoom. However, thanks to the occupation’s strong pay (exceeding $170,000 per year), young people still choose this path over many others, keeping the ratio of active job postings to employment slightly lower than the two above it on this list.

4. Magnetic resonance imaging (MRI) technologists

The most specialized roles on this list so far, MRI technologist positions are becoming increasingly hard to fill in 2026. As the population ages, demand for MRIs increases, making the need for skilled technologists to operate these machines even more critical. The hiring challenge is significant enough that many facilities have opted to upskill existing CT or X-ray technologists in-house rather than take on the cost and difficulty of recruiting externally.

5. Pediatric surgeons

Much like dentists and counselors, pediatric surgeons have a long way to go even after they graduate from college before they hit the job market. Along with eight years of schooling, they must pass licensing exams, complete a five-year surgical residency and a two-year fellowship, and then receive specialty board certification. Also, like many on this list, all of the work must be done in person. What keeps this occupation lower on this list is the number of pediatric surgeons in the U.S. These specialists are concentrated in a few major metropolitan areas. Smaller and rural hospitals often can’t afford — or don’t need — these surgeons, which caps how high demand can realistically climb.

6. Obstetricians and gynecologists (OB/GYNs)

For many of the reasons listed above, OB/GYNs are becoming increasingly hard to hire. High education requirements, lengthy residencies, extensive exams, and letters of recommendation all discourage younger people from entering the field. Paired with an aging workforce and high burnout rates among OB/GYNs, this causes demand to skyrocket. However, high compensation attracts a fair share of candidates, and the field is one of the smaller ones on this list. This places OB/GYNs at No. 6 on the Recruiting Difficulty Score.

7. Electrical and electronics installers and repairers (transportation equipment)

Just below OB/GYNs at No. 7 is the first occupation on this list outside education and healthcare. This is an extremely niche job with tasks that include the installation and maintenance of electronic communication equipment. As technology evolves rapidly, technicians increasingly need proficiency in areas they were never expected to master before. Modern transportation systems are software-driven rather than mechanical. As this occupation becomes less blue-collar, the talent pool shrinks. The candidates who would thrive in roles like this often become data analysts and software engineers instead, leaving recruiters scrambling to fill these positions.

8. Psychiatrists

Mental health demands have soared over the last decade, putting significant pressure on the supply of professionals in sectors like psychiatry. This spike in demand is compounded by the lengthy education requirements for psychiatrists, which means candidates can spend an entire decade training before they are even eligible to be hired. Notably, Lightcast data shows that 31% of employment for psychiatrists is within physician offices and medical group practices. These practices generally face greater hiring challenges because they offer lower compensation and fewer benefits, and they have smaller recruiting teams. Together, these conditions have made psychiatrists increasingly difficult to hire in the U.S. labor market.

9. Sales representatives (technical and scientific products)

Taking a different turn from many of the previously listed occupations, technical and scientific sales representatives have steadily become harder to hire in the U.S. Workers must typically acquire specific knowledge that requires lengthy training and education, while they also need to be skilled in persuasion, relationship-building, and closing deals. It can take up to 10 months for a new hire to reach full productivity. This causes hiring managers to be more cautious when evaluating candidates, extending the time-to-fill for these specific roles and contributing to their high RDS.

10. Cardiovascular technologists and technicians

As cardiovascular issues climb with the aging population, demand for cardiovascular technologists rises alongside them. Highly specialized training and certification requirements, along with grueling on-call shifts, leave candidate supply well below what is needed. Hospitals also compete with staffing agencies for the same pool of certified technologists, since travel and contract assignments typically offer higher hourly pay and more control over scheduling. The certification and schooling required to enter this occupation do not offer much career mobility, so younger students often choose more generalized healthcare paths instead. These factors lead to a limited applicant pool in an occupation where demand keeps rising.

What does this mean for recruiters?

Looking at this list, a clear pattern emerges — healthcare occupations are consistently among the hardest to hire for in the U.S. With expensive, rigorous, and lengthy education requirements, plus residencies and certifications to complete, it is no surprise that these jobs are more difficult to fill than others. All the occupations above require effort and highly specialized skills, while also being unsuitable for working from home, making it rarer for young people to choose these fields.

This isn’t to say that you should worry about running out of doctors anytime soon. Rather, the data suggests healthcare recruiters will struggle more than most in today’s labor market. For these difficult positions, recruiters typically need to spend significantly more to attract suitable candidates, which means a higher cost-per-application compared to the industry average.

This piece was written by our summer intern Logan Umbach, an undergraduate studying economics at Bates College. Sam Kuhn provided the analysis behind the ranking.