Two large nonprofit health systems have become among the biggest employers in the region. The state's economy is changing fast, and its numbers tell part of the story.

Regional health systems employ tens of thousands across the Dakotas.

What sets it apart

Sioux Falls and Rapid City anchor the state's largest medical campuses. For those who know the region well, it is a quiet point of pride.

Rural clinics and telehealth extend care across long prairie distances.

Why it matters

What ties it all together is a distinctly South Dakota balance between the wild and the worked-over. Whether the bet pays off or not, it is helping write South Dakota's next chapter.