2 H-2A workers as well as undocumented workers. The MSPA requires housing inspection and compliance with federal and state safety and health standards, provides itemized state- ments of earnings and deductions, and ensures that vehicles for worker transportation meet federal and state safety stand- ards and insurance requirements, and that each driver is properly licensed. The goal of these regulations is to protect all farmworkers from substandard and dangerous conditions. Farmworkers in Georgia usually arrive via Mexico, and they include not only Mexicans (the majority), but Cen- tral and South Americans, as well as some persons from the Caribbean. Farmworkers in southern Georgia are typically undocumented, and farmers rely on smugglers, known as coyotes, to shuttle them back and forth from Mexico to Geor- gia. Farmworkers come to Georgia looking for economic opportunities, but frequently undocumented workers’ ability to be ﬁnancially independent is untenable given the debts owed by farmworkers to a contractor. The contractor typi- cally ﬁnances the farmworker’s travels and living expenses, while expecting full reimbursement plus interest before the farmworker leaves his/her job [1]. In 1996 the Health Centers Consolidation Act established a centralized funding source for Migrant/Seasonal Farm- worker Health Centers, as well as health centers for other vulnerable populations. Today there are 154 migrant farm- worker health centers in 42 of the United States, which pro- vide health care to over 807,000 farmworkers [4]. Despite these health centers, access to health care remains a serious challenge to farmworkers. The major threats to migrant farmworker health docu- mented in the literature include occupational injuries, pesti- cide exposure, infectious disease, heat stroke, and dermato- logical conditions [5]. The working and living conditions of migrant farmworkers generate unique health hazards, due to both occupational challenges as well as injury and illness that stem from the conditions imposed by the culture of migrant farmwork, including dependency and poverty [6]. For exam- ple, food insecurity is prevalent among farmworkers in the state of Georgia, with as many as 63% reporting inadequate food. Undocumented workers have an adjusted risk of food insecurity 3 times higher than H-2A workers [3]. While sig- niﬁcant research has been conducted on occupational haz- ards of farmwork, such as pesticide exposure, injuries, and dermal conditions, there has been little focus on the diﬀeren- tial health risks encountered by farmworkers resulting from their marginalization. Farmworkers diﬀer from the general immigrant population in their relatively unhealthy and unac- culturated status. They also experience elevated rates of social and economic discrimination compared to the general immigrant population of the USA [5]. Multiple studies have been done of anxiety and depres- sion among farmworkers [7–13]. Joseph Hovey has written several articles on migrant farmworker health that highlight associations between high levels of depression and various risk factors, including family dysfunction, ineﬀective social support, hopelessness, and high acculturative stress. While there appears to be agreement among scholars that accul- turation leads to stress and increased incidence of mental health dysfunction, one study found that the prevalence of Nursing Research and Practice psychiatric disorders among migrant farmworkers was lower than for Mexican Americans and the US population as a whole, but increased with further acculturation and primary residence in the United States [12]. Although debates about migrant workers have emerged across the country, they are particularly volatile in the state of Georgia. As of July 1st, 2011, Georgia House Bill 87, The Ille- gal Immigration Reform and Enforcement Act of 2011, was enacted with the goal of deterring the undocumented from entering the state (House Bill 87). The law requires that busi- nesses and government agencies check the immigration status of new workers through a national system and impose ﬁnes of up to $250,000 and 15 years in prison on those who use false identiﬁcation. An additional provision requires people applying for food assistance and public housing to provide speciﬁc forms of identiﬁcation [14]. The state’s sixty- nine billion dollar a year agricultural industry is at stake with the passage of this new immigration law [15]. The purpose of this paper is to inform public debate by presenting empirical data about the scope of health challenges facing migrant farmworkers. Nurses play an important role in the care of migrant farmworkers in USA, but many more nurses are needed to care for farmworkers. This paper utilizes narrative analysis of a case study to illustrate, through the relationship of the narrator to migrant farmworkers and the participant observations of the co-authors, how isolation from family and community, as well as invisibility within institutions, impact the health and well-being of migrant farmworkers. 1.1. Theoretical Framework. Studies of migration have often been framed by “acculturation theory” also known as “assi- milation theory.” Acculturation theory is based on the assumption that immigrants succeed by adopting cultural practices of their host country and relinquishing those from their homes [22]. Reference [4] Theories of migration and health have held explanatory power for permanent—and not temporary—migration [1]. A 1997 review of accul- turation theory, tracing its evolution and widespread cri- tique, acknowledges the theory’s absence of recognition for the diversity of modern day immigrant populations from the global South. Alba and Nee discuss the weakness of acculturation theory in that “a more diﬀerentiated and syncretic conception of culture is needed, and a recognition that American culture was and is more mixed, much more an amalgam of diverse inﬂuences, and that it continues to evolve.” [16, page 834]. Nevertheless they deﬁne assimilation as the decline and ultimate disappearance of an ethnic/racial distinction with the social and cultural diﬀerences that express it. The idea that assimilation involves the disappear- ance of ethnic and racial distinction assumes recognition of individual subjectivity. Critical migration discourse obviates acculturation the- ory by the interrogation of the construct of citizenship. Citizens are recognized members of the state, entitled to protection, rights, material support, and a degree of political loyalty. Noncitizens, which include undocumented, or illegal persons are not so recognized [17]. The binary category of citizen/noncitizen serves to perpetuate the invisibility of non-citizens. States are called to contain and steward