Tuberculosis in the U.S. is increasingly noted among the foreign-born, with many individuals at risk being managed by international medical graduates (IMGs). We utilized anonymous surveys using hypothetical scenarios to assess and compare the attitudes of IMGs and U.S. medical graduates regarding the treatment of latent tuberculosis infection (LTBI) to identify how attitudes and intentions may influence physician behavior. IMGs were less likely to treat LTBI in almost all scenarios. Educational efforts should focus on IMGs to encourage attitudes more consistent with U.S. guidelines.