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Rising 2L here.

I am seeing that a LOT of Biglaw/Midlaw firms list immigration work in their practice areas. In my part of the country though, this is usually handled by small/solo practices, and almost always by a Spanish speaker.

I am angling towards a health law/medmal career. However, my school has excellent immigration law courses. Should I take one as a back-pocket, this-might-be-helpful-at-some-point thing? Or is the time better spent on focusing on other areas of the law that are more interesting to me and more in keeping with my career goals? I do speak a foreign language, but it's not Spanish, and probably would only be useful in some place like NYC or maybe Oregon.

Not sure what you're referring to about BigLaw/Midlaw referencing immigration work, this certainly isn't a significant focus of most big firms. That said, many firms have pro bono immigration opportunities, so taking a class might help you with that at a practical level. Also, personally, I found immigration law interesting since it's such a salient political issue these days.