Occupational therapy (OT) education has utilized fieldwork experiences to develop professional identity and clinical competency of entry-level OT practitioners since 1923. Level II OT fieldwork is viewed as a necessary and valuable experience by students, clinicians, and academicians. Despite the significant role fieldwork has in the formation of the future workforce, some educational programs report a shortage of OT fieldwork placement sites and the emergence of fee-for-placement fieldwork sites. The purpose of this study was to examine the prevalence and context of fee-for-placement for Level II OT fieldwork in the United States. Investigators surveyed master’s and doctoral level OT programs to examine their experience with requests for fee-for-placement fieldwork sites. The response rate was 32% (58 of 128 programs). Approximately two-thirds (67%, n=38) of respondents reported a decrease in number of Level II placement reservations. Eighty-two percent of programs reported encountering sites who requested fee-for-placement and almost half (43%, n=25) anticipated this trend to increase in the future. The majority of programs (89%, n=52) indicated they avoid placing students at fieldwork sites who charge for placement. The observed trend in fee-for-placement fieldwork may affect OT education by yielding significant implications related to finances, selection and placement processes, and compliance with professional values and ethics for programs and students. The concerns raised by the respondents may warrant a profession-wide consensus and direction toward addressing fieldwork shortages and fee-for-placements.