Over 2.1 million migrants work in jobs growing and processing food, playing an essential role in feeding Americans. They work in dangerous conditions and are exposed to pollution, deplorable living conditions and limited safety training. They are among the lowest paid and lack access to health information, preventive care and medical treatment. Dry skin, cuts, scrapes, rashes, chronic pain and broken bones are common among migrants who work in agriculture, poultry, and seafood processing in Maryland. These workers also suffer from numerous invisible injuries such as discrimination, verbal harassment and physical exploitation. Using archival and ethnographic research findings from an interdisciplinary health study investigating the impact of public health policy on farmworker health, we argue that racial capitalism has long been and continues to be an essential force in maintaining unequal health outcomes among migrant and immigrant workers in Maryland’s rural economy. Since the 1990s the power of corporate food supply retailers has grown, along with the demands for quality and agility in terms of the ability of growers and processors to increase or decrease supply at short notice. In the United States, this has resulted in an increased demand for international migrant workers hired through temporary employment visa programs. Our findings indicate that understanding the history of the contemporary capitalist food supply regime in Maryland involves confronting its roots in colonialism and slavery, including the regime's continued reliance on racialization and unfree labor, as well as contemporary modes of border imperialism.