I don't know about the US, but internationally it's not a monopoly by TOEFL. When I was looking at foreign uinversities for my Master's several programs were a

I don't know about the US, but internationally it's not a monopoly by TOEFL. When I was looking at foreign uinversities for my Master's several programs were accepted. For Sweden it's: TOEFL, IELTS, Cambridge Michigan Language Assessments, Pearson PTE Academic, University of Cambridge ESOL Examinations and possibly more (I got accepted with an old IB A2 degree).