In the US and Canada, the transition altitude is fixed at 18000 feet and the airspace above is known as the Standard Pressure Region
Under conditions of QNH at or above 1013 mb, FL180 becomes the lowest useable FL. If the pressure is lower, the lowest useable FL becomes FL190 or even FL200. This restriction ensures that a minimum of 1000' vertical separation is maintained between the aircraft at 17000' on QNH and the one at the lowest useable level on Standard Pressure Setting.