First, check and make sure that the six year limit really is where you think it is. After a recent USCIS policy change, you can now recapture trips outside the USA, so you may just have bought yourself a crucial extra few weeks.
If the employer filed the Labor Certification at least a year before the six-year limit is reached
In this case, you are eligible to apply for the so-called "seventh-year H-1B extension". This is actually a misnomer, because you can get an eighth, ninth and further year, too. In this case, H-1B extensions can be granted beyond the six year limit the same way as any other H-1B extension. The only difference is that these H-1B extensions are granted in increments of one year rather than three.
If the employer filed the Labor Certification recently (less than a year before the six years expire)
First, check if you have spent any time outside the USA. A recent USCIS policy change says that now, you can recapture any time you spent outside the USA - it used to be that vacations, business trips for your H-1B employer etc. all counted towards the six years. This is no longer the case.
In this case, you usually have to leave the USA. It is occasionally possible to change to a different status, such as student. In most cases, this is going to be difficult or impossible, because of clear evidence of immigration intent. Note that you cannot change to H-4 status in this case, because the H-4 status is subject to the same six year limit.
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