SIOUX FALLS, S.D. – A free, day-long event celebrating Native American culture through creativity, engaging performances and family-friendly activities returns to Levitt at the Falls this month.

The fourth annual Mitakuye Owas'iƞ *All My Relatives* Mitákuye Oyás’iŋ Festival will be held Saturday, Aug. 29.

"It's all about Native excellence and shining a spotlight on that," said president and CEO Nancy Halvorson of Levitt at the Falls.

To do so, the event includes live concert performances, a fashion show, guest speakers and cultural presentations, a visual arts exhibition at Rehfeld's Art & Framing, local artisan vendors, food trucks and family-friendly activities.

Rose Ann Hofland, vice president of programming of Levitt at the Falls, said the inspiration behind the festival grew out of earlier collaborations focused on creativity, Indigenous culture and youth engagement.

One of these events was Innoskate, a one-time event organized by the Levitt, the Smithsonian, USA Skateboarding and the Wokini Initiative of South Dakota State University. The purpose of the event was to celebrate creativity, skateboarding culture and create meaningful connections with certain tribal communities that do grassroots work in skateboarding.

The Wokini Initiative, dedicated to enhancing educational and cultural opportunities for Native American students, supported their work, allowing them to work with youth living on the Pine Ridge Reservation through an organization called Ground Control.

After seeing the positive impact of that event, Halvorson and Wokini wanted to continue fostering these relationships through featuring Native artists.

"From that, we said we really want to keep these relationships going and continue to build out this work, and so that's sort of where we said, 'What can we do here in Sioux Falls to really put a spotlight on Native artists and continue to grow these partnerships,'" Hofland said.

Funding for this year's event comes from the Smithsonian-wide initiative, 'Our Shared Future: 250,' that aims to commemorate the nation's 250th anniversary and advance the Smithsonian vision for the next 250 years.

According to Hofland, this event emphasizes the importance of celebrating and honoring Native culture in South Dakota.

"I think it's important for us to be continuing to shine a light on those folks who have contributed so much to what is the fabric of our cultural heritage here," Hofland said.

Native American art on display highlights native community

At Rehfeld's Modern fine art and framing, a wide variety of Indigenous artists are on display until Aug. 28, with a closing reception that day from 5 p.m.-8 p.m.

Alix Kyrie, gallery director at Rehfeld's, said she selects artists that speak to and reflect the native community. Each piece has a meaning that ties back to native artists.

This year, there are a mixture of artists from many different places – from as far as Montana, to as local as downtown Sioux Falls.

Current artists on display include: Holly Young (ledger), John Pepion (ledger), Amanda Provost (photography) and Jane Williams (oil).

Kyrie said having an intimate display of the artist's works helps foster connections between artists and viewers.

"There's always a little bit of a deeper meaning than just like, 'Oh, that looks cool.' And again, that's the nice thing about having a smaller group of artists is I can pick up the phone and be like, 'Hey, you brought in this cool piece, but what does it mean?'" Kyrie said.

Creative expression through music

Paintings, drawing, sculptures and pottery are not the only art forms featured at the upcoming festival.

Mato Wayuhi, an Oglala Lakota actor and musician from Sioux Falls, will be coming back for a second year to the All My Relatives festival.

Growing up, Wayuhi said he did not know art was a viable career path. He has always been interested in being creative, saying creativity is a part of Lakota culture. But it was not until he saw young artists online making music that he realized he could pursue this full-time.

For Wayuhi, hip-hop music resonates with him the most. He draws influence from artists such as former hip-hop collective Odd Future, core members notably being Tyler, the Creator, Frank Ocean and Earl Sweatshirt.

"I became more myself when I fell in love with hip-hop," Wayuhi said. "It's kind of always within me, and I think that a lot of natives gravitate to Black culture and hip-hop culture in general because there's just that shared feeling of history and disenfranchisement and all these kind of things."

Wayuhi said he likes when his fans can relate to him.

"I have had a lot of people find relatability in it, and I'm always striving for more of that ... without compromising any sort of spiritual vision that I have," Wayuhi said. "I got messages from people that were, you know, saying, 'I'm half white, half Palestinian,' 'I'm half, you know, Mexican and Black.' And it was cool because they were like, 'Thank you for writing something like that because I could relate to it.'"

Correction on Aug. 7: The CEO of Levitt at the Falls is Nancy Halvorson. An earlier version of this story incorrectly stated her name.

South Dakota News Watch is an independent nonprofit. Read, subscribe for free and donate at sdnewswatch.org. Elena Tittel's internship was funded with support from the Nonprofit Newsroom Internship Program created by The Scripps Howard Fund and the Institute for Nonprofit News. Contact: elena.tittel@sdnewswatch.org.

Updated Aug. 5 to remove the Democratic candidate for U.S. Senate and add additional information about other candidates.

Regardless of your voting experience or party affiliation, this guide is intended to help South Dakotans make informed decisions in the 2026 primaries and general election. It uses fact-based reporting to fairly and clearly explain the process and who and what is on the ballot.

The guide will be updated as new information becomes available, so bookmark it and share it with family and friends. Send questions, suggestions or corrections to info@sdnewswatch.org. Read all government and political stories, including polls, profiles, ballot issue explanations and other topics.

Important dates and voting basics

Who's on the ballot

Here are the statewide federal and state offices with races in 2026. Candidates are listed in alphabetical order by last name. Party affiliations are Democratic (D), Independent (I), Libertarian (L) and Republican (R). Incumbents are noted with an asterisk (*). See local races and more information, including live results, on the Secretary of State's website.

Tribal elections include leadership shakeup in Flandreau

What else is on the ballot

The following "yes/no" ballot measures have been approved for the Nov. 3 general election ballot, all of which were referred by the Legislature. Here is more information about ballot questions on the Secretary of State's website.

News Watch's political reporting standards

Here are FAQs about South Dakota News Watch's political reporting standards.

Help guide our coverage to better serve South Dakota

We strive to cover issues important to you, but that can be difficult in a large, diverse state. Please fill out this survey and help guide what fact-based news and information we provide to all South Dakotans for free, especially during important election years like 2026. Most of the questions are optional, so can answer only those you have thoughts about. Thank you for your help!

Sources for this guide include original reporting and publicly available resources provided by the South Dakota Secretary of State's office. It only includes information on statewide and legislative races. Details about local races can be found on each county auditor's website and the state's great local media outlets.

South Dakota News Watch is an independent nonprofit. Read, subscribe for free and donate at sdnewswatch.org. Contact reporter/Report for America corps member Molly Wetsch: 605-531-7382/molly.wetsch@sdnewswatch.org.

No.

South Dakota does not charge fees for residents to get a concealed firearm permit, after former Gov. Kristi Noem signed Senate Bill 212 into law in 2022.

The bill removed state and county permit fees. The Secretary of State’s office reimburses counties for the lost revenue based on the number of permits issued each year.

Gov. Larry Rhoden, who succeeded Noem in 2025, has been supportive of the Second Amendment right to carry, passing multiple laws that lowered gun restrictions. In March 2025, he signed three of those bills.

SB 100 made South Dakota the 12th state to allow concealed carry on college campuses. House Bill 1222 released the ban of carrying a concealed pistol in vehicles in school parking lots. The third measure, HB 1218, took away the ban on carrying concealed weapons into bars, while allowing city and county employees to carry a concealed pistol at work.

Sources

South Dakota codified laws, 2022 Senate Bill 212

South Dakota codified laws, 2025 Senate Bill 100

South Dakota codified laws, 2025 House Bill 1222

South Dakota codified laws, 2025 House Bill 1218

South Dakota News Watch, What concealed carry on campus means for South Dakota schools

About fact briefs

Fact briefs are bite-sized, well-sourced explanations that offer clear "yes" or "no" answers to questions, confusions and unsupported claims circulating online. They rely on publicly available data and documents, often from the original source. Fact briefs are written and published by South Dakota News Watch as part of the Gigafact network. Submit a question for us to answer on the tipline.

South Dakota News Watch is an independent nonprofit. Read, donate and subscribe for free at sdnewswatch.org. Contact freelance reporter Emily DeCock: emily.decock@sdnewswatch.org.

BROOKINGS, S.D. – International enrollment at South Dakota's public universities has increased steadily over the past several years. But university leaders expect fewer students from other countries this fall as visa uncertainty and changing federal immigration policies create doubt among prospective students.

At the same time, employers across the state, from tourism businesses like Wall Drug to hospitals, schools and agricultural operations are still searching for workers in a tight labor market while navigating increasingly complicated visa programs.

Interviews with immigration attorneys, international student advisers and employers suggest that hesitation surrounding student and work visas has grown as federal processing times extend and immigration policies evolve fast.

How SD hospitals fared in the latest quality ratings

"There is a lot of uncertainty," said Casey Eekhoff, an immigration attorney with Eekhoff Law, Prof. in Sioux Falls, who has practiced immigration law for more than a decade. "Things that used to take much less time are now taking two years or more."

New federal rules shift rules for international students

Adding to mounting uncertainty across higher education, the U.S. Department of Homeland Security (DHS) finalized a major regulatory overhaul on July 17 that eliminates the longstanding "Duration of Status" framework for international students and exchange scholars.

For decades, F-1 student visa holders – the primary federal visa category for full-time international students attending U.S. colleges and universities – were permitted to reside in the United States for as long as they maintained good academic standing and full-time enrollment.

Under the new rule taking effect Sept. 15, international students will be locked into fixed admission periods tied directly to their program length, capped at a maximum of four years.

Students who pursue complex multi-year research projects, change academic majors or seek advanced doctoral degrees will now have to submit formal extension applications and pay additional administrative fees to remain in the country legally. Those fees go to U.S. Citizenship and Immigration Services (USCIS), the federal agency that oversees legal immigration and work permits.

Some higher education advocates said these added hurdles, paired with a post-graduation departure grace period reduced from 60 days to 30 days, risk deterring top global talent at a time when domestic enrollment is down.

State leaders warn of regional economic impact

The tension between federal immigration policies and local workforce needs is drawing concern from state financial leaders. During a national press briefing on July 16, they warned that restricting legal visa pipelines threatens long-term structural damage to Midwestern economies.

Minnesota State Auditor Julie Blaha said agricultural and health care dependent states in the Upper Midwest are uniquely vulnerable when high-skilled visa channels are constricted.

"Foreign-born workers make up a critical part of our regional labor force," Blaha said, noting that visa delays directly impact rural health care access and technical support for advanced agriculture. "We are dependent on having our new neighbors stay here and be successful. If we try to keep immigrants out, it will hurt us at every level, from paychecks to access to health care."

Colorado Treasurer Dave Young pointed out that policy uncertainty prevents regional employers and research institutions from planning for the future. He noted that limitary visa rules hit rural states like South Dakota just as severely as major technology hubs.

"When you narrow the field, particularly in rural parts of the country, you eliminate the prospects for smart hiring," Young said. "You want the most competent people to have an opportunity to come to your state, deliver effective services and add research value."

Less worry about getting admitted and more about staying compliant

South Dakota State University's Office of International Affairs said prospective students still ask traditional questions about housing, tuition and campus life. But immigration rules now dominate many conversations.

Students frequently ask how federal rules may change, how future visa policies could affect them and what they can do to strengthen their chances of receiving or maintaining an F-1 student visa.

"We're hearing lots of questions about what U.S. visa regulations look like," said Kirsten Linke, the director of Office of International Affairs at SDSU.

The office also has seen more concern about travel limitations affecting students from certain countries and uncertainty surrounding future immigration policy.

Linke said SDSU expects fewer international students this fall than in previous years, reflecting nationwide suspense surrounding federal immigration policies.

Nevertheless, cycles of enrollment increases and decreases have occurred before, she said.

According to South Dakota Board of Regents data, international enrollment increased at each of the state's six public universities between 2021 and fall 2025. South Dakota State University enrolled 865 international students in fall 2025, compared to 615 in 2021. Comparable increases occurred at the University of South Dakota, Dakota State University and the remaining public universities.

Despite the fact that enrollment has steadily increased, universities now expect fewer international students this fall because of growing uncertainty surrounding visa processing and federal immigration policies.

Eekhoff said one of the biggest misunderstandings students have is believing immigration rules allow flexibility.

"In reality, they're very unforgiving," she said.

Students sometimes suppose they can begin working while paperwork is pending or accept unauthorized employment without consequences. Federal immigration rules generally ban those actions.

Work authorization and strict deadlines

Employment authorization presents another challenge. Students participating in Curricular Practical Training (CPT) or Optional Practical Training (OPT) often underestimate how important timing can be.

CPT is an off-campus work authorization program that allows enrolled international students to accept paid internships, practicums or jobs if the work is directly related to their major and required by their degree program.

OPT gives temporary work authorization to international graduates, allowing them to work in their field of study in the U.S. for up to 12 months after graduation or up to 36 months for graduates in science, technology, engineering and math (STEM) fields.

While CPT is managed and approved directly by university advisers, OPT requires formal government application and approval through USCIS, making strict adherence to processing deadlines essential.

"You don't want to start working before you're authorized," Eekhoff said.

Longer federal processing times have made planning more important, she added. Students should begin discussing long-term employment options with employers well before graduation, especially if H-1B visa sponsorship may be needed.

That's the standard federal work visa that allows U.S. businesses to temporarily employ foreign professionals in specialized occupations requiring a college degree.

State labor data highlights growing demand

South Dakota employers rely on international workers to help fill labor shortages in various industries as the state's job market expands.

Data provided by Dawn Dovre, communications director for the South Dakota Department of Labor and Regulation (DLR), which works directly with state-level H-2A agricultural and H-2B non-agricultural seasonal visa programs, highlights how critical short-term and seasonal labor is across the state.

In May 2026 alone, South Dakota’s non-farm wage and salaried workforce expanded by 9,400 workers to reach 475,200, driven largely by seasonal surges in leisure and hospitality (up 4,200 workers) and construction (up 2,500 workers).

While state labor data highlights broad industry trends, individual businesses demonstrate how deep the reliance on international labor runs.

Few South Dakota employers illustrate that need more clearly than Wall Drug, the tourist stop advertised around the world through road signs.

Amanda Frink, HR director at Wall Drug, said the business brings in about 115 seasonal employees each summer, with most arriving from other countries to fill roles across retail, food service and maintenance.

"We have to have that many workers," Frink said. "The American database of people that are available to work is very slim."

However, securing that workforce has grown increasingly complex.

Employers relying on non-agricultural seasonal labor depend on H-2B visas, which are distributed through a federal lottery.

Meanwhile, student workers arriving on J-1 visas faced high denial rates at foreign embassies this year. Those exchange visitor permits allow foreign university students to work and travel in the U.S. during summer breaks.

"This year was the highest visa denial rate I've ever seen in the last four years," Frink said.

Administrative bottlenecks forced some international staff to arrive as much as a month later than scheduled, creating operational stress during peak tourist season, she said.

Despite the administrative difficulties, Frink emphasized that international workers remain essential to keeping operations running smoothly.

"Their work ethic is usually great," she said. "They're usually very efficient employees."

Year-over-year trends reflect steady expansion in key service and health care sectors. Between May 2025 and May 2026, leisure and hospitality added 2,300 jobs, while health care and social assistance gained 1,200 workers, according to DLR data.

Looking long-term, state projections point to South Dakota’s job growth outpacing the national average. Between now and 2032, state employment is expected to grow 7.7%, compared to 2.8% nationwide.

According to DLR industry trends, the fastest-growing sectors statewide will be professional and technical services (15.2%), health care and social assistance (12.0%), transportation and warehousing (11.8%), construction (11.5%), and arts, entertainment and recreation (10.5%).

Health care and educational services account for nearly half of all advertised job openings statewide, while retail, hospitality and business administrative roles make up much of the remaining demand, the trends indicate.

Eekhoff said businesses across these top-hiring sectors frequently turn to legal immigration programs to fill lingering vacancies, particularly in rural communities contending with sharp labor shortages.

"I see agriculture, hospitality, tourism, food processing, health care and education," she said. "Especially in rural communities where workforce shortages exist."

High-skilled visas power higher education and health care

Federal workforce filings also illustrate how deeply embedded international talent is within South Dakota’s core institutions.

According to data from the USCIS H-1B Employer Data Hub, 220 employers across South Dakota accounted for 5,089 approved high-skilled visa beneficiaries through early 2026.

Major regional health care networks, including Sanford Health and Avera McKennan in Sioux Falls and Monument Health in Rapid City, account for most of remaining top sponsors, utilizing visa programs to staff regional hospitals and rural clinics dealing with severe, ongoing labor shortages.

High-skilled visa pipelines also faced uncertainty after a September 2025 presidential proclamation attempted to impose an additional $100,000 filing fee on new H-1B petitions for workers hired from abroad. A federal district court in Massachusetts struck down the fee on June 8, ruling that the administration exceeded its authority, and the First Circuit Court of Appeals denied a federal request to reinstate the fee on July 24 while litigation continues, according to official USCIS guidance.

While financial services lead overall raw volume, high-skilled visas are heavily concentrated in public education and medical infrastructure. South Dakota State University ranks fourth statewide with 236 approved beneficiaries, underscoring the land-grant university's reliance on global scholars to drive research and instructional demands.

At SDSU, those high-skilled visa holders primarily consist of faculty members, while the remaining positions are filled by postdoctoral fellows and research scholars, according to Jill Fier, SDSU's digital news and media relations coordinator.

Fier explained that the university opens its recruitment to all qualified candidates regardless of national origin, prioritizing hiring the most qualified candidate for every role.

"All SDSU faculty, including international faculty, researchers and specialized professionals, bring expertise and knowledge that supports the university’s research and academic mission and goals," Fier said, highlighting that international scholars are a crucial part of any university's educational programs and research endeavors.

She noted that SDSU closely monitors and complies with evolving federal requirements regarding the H-1B process and broader immigration policies.

Communication matters

Eekhoff and Linke said many immigration problems can be avoided simply by asking questions early.

The SDSU Office of International Affairs encourages students to build relationships with their international advisers rather than relying on advice from other students.

"Please don't take advice from your friend unless they say, 'Go talk to the international adviser,'" Linke said.

Eekhoff offered similar guidance.

"I wouldn't be afraid to ask," she said. "Make sure you're always in compliance with the expectations and requirements of your status."

Congressional offices provide limited immigration assistance

South Dakota's three congressional offices can sometimes help constituents experiencing delays with federal agencies.

Michael Finan, press secretary for U.S. Sen. John Thune, said South Dakotans experiencing problems with federal agencies are encouraged to contact the senator's office for assistance.

U.S. Rep. Dusty Johnson's office refused to comment.

"Unfortunately, we do not comment on constituent casework and casework processes," said Press Secretary Andrew Rasmussen.

Editor's note: Amina Aidarkhanova is from Karaganda, Kazakhstan, and attends SDSU in Brookings on a student visa.

South Dakota News Watch is an independent nonprofit. Read, subscribe for free and donate at sdnewswatch.org. Amina Aidarkhanova received the 2026 Jeffrey B. Nelson Investigative Journalism Endowed Internship and the Chuck Raasch and Sandy Johnson Scholarship from the SDSU Foundation. Contact: amina.aidarkhanova@sdnewswatch.org.

While most Americans know it's among their civic responsibilities to be informed and vote, a lot of people are checking out of both.

As the United States celebrates its 250th anniversary, organizers of an interactive presentation hope to increase engagement by delving into the role civics and communications – from Revolutionary War papers to podcasters – have played in the nation's history. That includes the separation of powers among the branches of government and the system of checks and balances, the various civic duties and responsibilities of being an American, and how to find trusted sources of news and information.

The hourlong sessions, titled "250+ Years of American Civics and News," have received positive audience feedback in Yankton, Rapid City, Pierre, Brookings, Vermillion, Watertown, Mitchell and Sioux Falls.

Here are details of the next stops:

Custer State Park, Sunday, Aug. 9 – Kathy Johnson, president of the League of Women Voters of South Dakota, and Carson Walker, CEO of South Dakota News Watch, will lead the presentation at the Black Hills Playhouse (24834 S. Playhouse Road) immediately after the 2 p.m. MT matinee of the fourth play of the season, "What the Constitution Means to Me." News Watch is the title sponsor of the play, so please indicate you'd like to be seated with other supporters when ordering tickets and stay for a social time afterward.

Brandon, Sunday, Oct. 25 – details forthcoming.  

The series is sponsored by News Watch, SDPB, the League of Women Voters of South Dakota, the Chiesman Center for Democracy at the University of South Dakota and the Mike Huether Public Service Academy at South Dakota State University.

To schedule a session with your school, service club or other organization, contact Walker at 605-610-9366 or carson.walker@sdnewswatch.org.

South Dakota voter guide

South Dakota News Watch is an independent nonprofit. Read, subscribe for free and donate at sdnewswatch.org. Contact: info@sdnewswatch.org.

Yes.

South Dakota is one of about 10 states where the use of cameras to enforce traffic violations is against the law. 

The South Dakota Legislature passed the law banning the cameras in 2014. It states that “no state, county, municipal, or township authority may contract with any private corporation to provide for the use of any photo monitoring device to detect any red light violation.”

In 2006, I.L. Wiedermann's vehicle was photographed violating a “no turn on red” sign in downtown Sioux Falls. He was subsequently fined $86 and appealed before taking the case to circuit court in 2010.

The lawsuit claimed the city violated state law by placing a camera at the downtown intersection, violated his due process rights and exceeded legal authority by assessing a civil penalty for a traffic offense. The circuit court ruled in Wiedermann's favor.

Four years later, the Legislature banned the cameras.

Sources

South Dakota codified laws, 32-28-17

World Population Review, Red light cameras

Circuit Court of South Dakota, I.L Wiedermann vs. City of Sioux Falls

Sioux Falls Argus Leader, S.D. House unanimously votes to ban red light cameras

About fact briefs

Fact briefs are bite-sized, well-sourced explanations that offer clear "yes" or "no" answers to questions, confusions and unsupported claims circulating online. They rely on publicly available data and documents, often from the original source. Fact briefs are written and published by South Dakota News Watch as part of the Gigafact network. Submit a question for us to answer on the tipline.

This story was updated.

South Dakota News Watch is an independent nonprofit. Read, donate and subscribe for free at sdnewswatch.org. Contact freelance reporter Michael Klinski: michael.klinski@sdnewswatch.org.

Two hospitals in South Dakota were rated "below average" in 2026 based on a regular review of patient care and medical outcome benchmarks set by the federal government.

But those poor results were far from the norm, as most hospitals statewide received average or better grades in the annual Overall Hospital Quality Star Ratings determined by the U.S. Centers for Medicare & Medicaid Services (CMS).

The ratings – ranging from 1 star on the low end to 5 stars at the top – are based on 46 quality measures within five general categories of health and safety data, which are supplied by the facilities being rated or collected independently by CMS. The categories include mortality, safety of care, readmission, patient experiences and timely and effective care.

The two South Dakota hospitals rated 2 stars in 2026 were Avera St. Mary's in Pierre and Huron Regional Medical Center. Both had some positive and negative findings in their overall reviews, but they had lower-than-average recommendation rates by patients.

No South Dakota hospital had a 1-star or 2-star rating in 2025.

Five hospitals received top 5-star marks in 2026, up from three last year. The top grades went to Avera Heart Hospital in Sioux Falls, Avera St. Benedict in Parkston, Sanford USD Medical Center in Sioux Falls and the Veterans Affairs hospitals in Sioux Falls and Sturgis.

How a hospital is helping solve a hometown housing shortage

Taken as a whole, South Dakota's ratings were slightly better on average than the rankings of the nearly 3,000 American hospitals that receive a CMS star rating each year.

Ratings only one way to judge hospital quality

The rating system, found at the Care Compare website, "displays hospital performance data in a consistent, unified manner to ensure the availability of credible information about the care delivered in the nation’s hospitals," according to CMS.

Tim Rave, CEO of the South Dakota Association of Healthcare Organizations, declined to comment on any individual hospital's rating.

But he called the ratings "an important benchmark" and added they are far from the only metric hospitals and the public should use to evaluate the quality of patient care.

"While the overall star rating provides helpful information for consumers, hospital leaders rely on much more detailed data to identify opportunities for improvement and ensure they are providing safe, high-quality care," Rave said in an email to News Watch.

Rave said the ratings provide a useful "snapshot" of hospital performance in a confined period of time but can't fully encapsulate the hundreds of data points providers use to evaluate and improve their performance.

"A single overall rating cannot fully capture the complexity of caring for diverse patient populations, the broad range of services hospitals provide, or the unique role each hospital plays within its community," Rave wrote.

How did each South Dakota hospital rate?

Here is a look at how each South Dakota hospital that was rated fared in 2026, with the 2025 Star Rating included in parentheses where applicable. Several hospitals in the state did not have high enough patient counts or data reports to qualify for a CMS rating.

5 stars (much above average):

• Avera Heart Hospital, Sioux Falls (5 stars in 2025)
• Avera St. Benedict Health Center, Parkston (no rating in 2025)
• Sanford USD Medical Center, Sioux Falls (4 stars in 2025)
• VA Medical Center, Sioux Falls (5 stars in 2025)
• VA Healthcare System, Sturgis (4 stars in 2025)

4 stars (above average):

• Avera McKenna H/UMC, Sioux Falls (3 stars in 2025)
• Avera Queen of Peace, Mitchell (no rating in 2025)
• Avera St. Luke's, Aberdeen (5 stars in 2025)
• Brookings Health System, Brookings (4 stars in 2025)
• Monument Health, Spearfish (no rating in 2025)
• Sanford Medical Center, Aberdeen (4 stars in 2025)

3 stars (average):

• Avera Sacred Heart, Yankton (4 stars in 2025)
• Monument Health, Rapid City (4 stars in 2025)
• Prairie Lakes Healthcare, Watertown (4 stars in 2025)

2 stars (below average):

• Avera St. Mary's, Pierre (3 stars in 2025)
• Huron Regional MC, Huron (no rating in 2025)

1 star (much below average):

• No South Dakota hospital at this rating
• Deficiencies found at two lowest-rated hospitals

Huron and Pierre numbers explained

Huron Regional Medical Center, one of the two 2-star rated hospitals in South Dakota, received strong marks for efficiency in emergency room treatment times and for safe use of opioids.

But the hospital received lower-than-average marks in quality of sepsis care, the death rate for pneumonia patients and the overall death rate of patients, which was 5.4% compared to the national average of 4.2%.

The hospital did not participate in any programs to improve maternal or child health outcomes.

The hospital was also cited for low marks on some areas of in-patient surveys. Only 63% of patients at Huron Regional said their rooms and restrooms were always clean, compared to an average of 77% of perfect cleanliness reports at other South Dakota hospitals. And 57% of patients would recommend Huron Regional, compared to an average recommendation rate of 76% at other hospitals statewide.

Pierre's St. Mary's received strong marks in sepsis care and colonoscopy follow-up screening as well for consistent communication to patients by doctors and nurses.

But St. Mary's received lower-than-average ratings in the rate of stroke patients who received rapid brain scans and for longer-than-average treatment times in the emergency room.

The hospital's death rate for heart attack patients was 17.3%, above the U.S. average of 11.6%. CMS also noted that a lower-than-average number of mammogram patients received advanced screening after their initial test.

Only 61% of patients said on surveys that they would recommend St. Mary's, compared to the statewide average recommendation rate of 76% at other hospitals.

Hospitals use ratings as motivation

Cale Feller, director of media relations and corporate communications for Avera Health, told News Watch in an email that the health system is dedicated to constant improvement in patient care.

Feller said the CMS ratings use data from as far back as 2021 and there is a slim margin between star rating levels.

"Avera’s commitment to deliver safe, effective and compassionate care remains steadfast," Feller wrote to News Watch in an email. "Our quality data remained consistent with last year, reflecting the high standard of care we provide."

The CMS hospital rating website shows that while some data used to determine star ratings is from 2021, much of the new analysis is based on information from 2023 and 2024.

Feller did not specifically address the CMS rating for Avera St. Mary's in Pierre, which fell from a 3-star rating in 2025 to a 2-star rating this year.

Monument Health representatives said they have taken numerous steps toward improving patient care and outcomes at Rapid City Hospital, which raised its star rating from a 1 in 2023 to a 4 in 2025. The Rapid City hospital fell to a 3-star rating this year.

For several years, Monument in Rapid City has implemented a "daily huddle" and 5-tier prioritization system in which problems are documented and addressed as quickly as possible.

"Many of our quality outcomes remain strong and continue to improve," Melissa Haught, director of communications at Monument Health, wrote to News Watch in an email.

Haught said the hospital has seen continued reductions in hospital-acquired infections and surgical complications in hip procedures, among other improved outcomes.

"Rapid City Hospital performs better than the national average on seven of the 11 measures included in CMS's hospital readmissions domain, demonstrating strong performance across several key indicators of patient outcomes," Haught wrote.

Both Feller and Haught said their health systems have used the CMS ratings as motivation to improve, and that both systems took specific actions to improve patient care and potentially boost future ratings.

That sentiment was shared by Destiny Price, chief operating officer at Huron Regional, which voluntarily entered into the CMS evaluation system last year, knowing that some deficiencies would likely be highlighted in the rating.

"We recognized the value of being transparent to identify where we’re not hitting all the targets so we can start working on those things," Price told News Watch in an interview.

For example, before the 2-star rating was announced, leaders of the 25-bed hospital recognized issues in sepsis care and took steps to minimize infections and improve outcomes, Price said.

Huron Regional has also created a multi-disciplinary team that meets daily with each hospitalized patient, added a chronic care nurse and community health worker, and has a renovated birthing center and a new robot to aid in orthopedic surgeries. The hospital has also implemented processes to analyze systems and outcomes to identify and solve any issues that arise.

"The quality of care we deliver now is not reflected in the rating," she said. "The board opted to say, 'Hey, let's report (to CMS), and we know it might be painful, and we might get a black eye ... but if we're working hard and always being aware of patient safety, then we'll have better outcomes for our family, friends and community members, which is who we take care of.'"

Correction on Aug. 3, 2026: An earlier version of this story misspelled "results" in the second paragraph.

South Dakota News Watch is an independent nonprofit. Read, subscribe for free and donate at sdnewswatch.org. Contact content director Bart Pfankuch: 605-937-9398/bart.pfankuch@sdnewswatch.org.

SIOUX FALLS, S.D. – A grant program providing funding for community oriented projects is supporting a food truck operation to deliver meals to tribal communities.

Team Buche Cares - Underdog Foundation, the nonprofit arm of GF Buche Co., aims to serve families in need and offer meaningful change on behalf of the communities they serve. One way they do this is through the Mobile Hunger Hero, a food truck able to deliver a large number of meals to remote locations.

Carrie Sanderson, executive director of Team Buche Cares, said the idea came from an experience CEO and president RF Buche of the GF Buche Co. had two years ago. He was feeding about 5,000 children a day at the Pine Ridge Reservation by the end of the summer, which opened his eyes to the need for more accessible food.

"He knew he was going to make his life mission to continue to fight food insecurity across rural and tribal areas," Sanderson said. "He said, 'We need a food truck. We need to be able to get a mobile pantry out to the people.'"

Team Buche Cares purchased the Mobile Hunger Hero in 2025 that currently serves about 121 rural and tribal communities across the state. In 2026 alone, there have been 38 food distributions detailed in the graphic below.

Sanderson said as their operation was growing, they recognized a grant was a needed area for them to tell their story and show proof of concept with the Mobile Huger Hero.

Partnering with the Bush Foundation based in St. Paul, Minnesota, South Dakota Community Foundation will award $1.2 million each year for six years to eligible nonprofits in South Dakota. This marks the fifth year of the initiative.

The Underdog Foundation was selected as one of 13 nonprofits chosen as a 2025 recipient from a pool of 143 applicants. (South Dakota News Watch received $100,000 for its housing solution stories.)

Ginger Niemann, senior program officer at South Dakota Community Foundation, said the Beyond Idea Grant Program was designed to fund established or early stage projects that are in the process of developing, testing or spreading ideas that can make the region better for everyone.

"Being able to get the food in the hands of those who really need it through a food truck was really an important initiative that the reviewers saw that met all the criteria that the Beyond Idea Grant Program wishes to see," Niemann said.

Since receiving the grant six months ago, they have been able to improve their tracking systems as well as coordinate outreach and communication regarding when the distributions are occurring.

As of now, Team Buche Cares has been able to complete monthly distributions in addition to holiday meal giveaways. The goal is to continue completing at least one distribution a month.

Food insecurity in South Dakota

According to 2023 Feeding America data, approximately 113,750 people are food insecure in South Dakota, meaning they have limited or unstable access to adequate food.

Those experiencing food insecurity often deal with high living costs, expensive housing, unemployment and low-wage jobs. Taken together, this can lead to poor physical and mental health and negative educational and occupational outcomes.

Rates of food insecurity range from 8.5% in Hanson County to 28.2% in Oglala Lakota County, which comprises part of the Pine Ridge Indian Reservation. Todd County, Oglala Lakota County and Corson counties have the highest percentage of individuals experiencing food insecurity shown in the graphic below.

People who are food insecure are also more likely to be malnourished. Malnutrition can lead to numerous adverse health outcomes. These include but are not limited to poor growth, intellectual impairments, perinatal complications and increased risk of morbidity and mortality.

Native Americans in South Dakota have the highest rate of deaths from avoidable causes in the nation. The 2026 State Health Disparities Report from the Commonwealth Fund found deaths from avoidable causes among Native Americans was 1,089 deaths per 100,000 people. That's 5 times the rate of white South Dakotans.

Sanderson said that for people living in some of these communities, accessing a grocery store can be difficult. Some people may have travel long distances the nearest grocery store, and if there is a lack of transportation, this becomes even harder.

"When we talk about food deserts in Sioux Falls, we're talking about not having a grocery store within a mile- or 2-mile radius," Sanderson said. "In many of our communities, grocery stores are in that 25- to 50-mile range."

However, even for those who can access a grocery store, they may not have proper ways to store their food or be able to afford healthy options, Sanderson said.

What to know about food resources in SD

Looking forward, she said they hope to buy an additional truck to further expand distributions within the nine tribal reservations.

"It's a fun project to be a part of, and I think the the best thing is seeing change at every time you're able to do a food distribution. How grateful people are, and just knowing that access to food will create stronger students, stronger community workers and relieve some burdens on health care and even law enforcement by having access to good food," Sanderson said.

South Dakota News Watch is an independent nonprofit. Read, subscribe for free and donate at sdnewswatch.org. Elena Tittel's internship was funded with support from the Nonprofit Newsroom Internship Program created by The Scripps Howard Fund and the Institute for Nonprofit News. Contact: elena.tittel@sdnewswatch.org.

RAPID CITY, S.D. – Based on information released by authorities so far, two cybersecurity experts said it is likely that a malicious foreign entity is behind the recent cyberattack that crippled communications and other computer-based systems in Pennington County government.

Two federal agencies, meanwhile, have recently warned state and local governments across the U.S. that cyberattacks are increasingly likely, and that such attacks are likely to originate in Iran, China or Russia.

On July 5, Pennington County announced that a "cybersecurity incident" had occurred and affected parts of the county's computer network. The county shut down public access to government services for a day and has since embarked on a major multi-agency investigation. The county continues efforts to bring back communication and other computer-based systems.

"The biggest concern that I have is a cyberattack that leads directly to a loss of life or multiple people losing their lives. There needs to be a prioritization of security across all government entities and health entities."
– John Strand, owner of Black Hills Information Security, a Sturgis-based company that is an industry leader in cybersecurity

County officials said critical county services such as the sheriff's office, courts, 911 dispatch and jails have remained operational since the incident. Several county functions such as computer-based communications, internet access and providing record keeping and registration services to the public were slowed or otherwise affected by the incident and response.

Pennington County State's Attorney's Office spokeswoman Katy Urban, who is handling all media contacts during the investigation, told News Watch that the county is not discussing the incident or the subsequent investigation and is limiting public statements to those related to how residents can access government services.

"Unfortunately, there's not a lot I can say because it's an ongoing investigation," Urban told News Watch. "If anyone's personal information has been compromised, we will contact them directly as required by state law."

Likelihood a foreign government is behind it

Elements of the cyberattack point to an adversarial foreign government as the responsible party, said John Strand, owner of Black Hills Information Security, a Sturgis-based company that is an industry leader in cybersecurity.

Strand told News Watch in an interview that cyberattacks on American government entities typically originate from one of two sources: international organized crime groups that seek money from victims or international adversaries that either seek intelligence on U.S. networks and systems or intend to disrupt daily life in America.

Since county officials have not discussed any demands for ransom from the cyberattacker, it is more likely that a foreign adversary of the U.S. is behind the attack, Strand said.

"So then you're looking at Iran, you're looking at Russia, you're looking at China," Strand said. "Most of the time, they want to dwell (within the system) and to gain access to critical infrastructure, and they want to maintain access for as long as they possibly can."

The New York Times on July 30 quoted anonymous state and federal sources in an article indicating that Iran is the likely culprit of a major cybersecurity attack that sought to disrupt water systems in more than 30 communities across Minnesota in late July. The Times said federal officials were concerned the cyberattacks could be a new salvo by Iran in its ongoing war with the United States.

The goal of a dwell is to gain access to a system, stay there as long as possible and gain intelligence about how American systems work or where vulnerabilities may lie, Strand said.

"If you're looking at Iran, though, right now because we are in a hot conflict, their motivations would be very different," he said. "They may want to gain access and cause immediate damage to get the press around what they were able to do in the United States."

A more aggressive cyberattack could not only disrupt critical services in the U.S. but could interfere with systems that keep people safe, Strand said.

For example, a cyberattacker could contaminate or limit access to drinking water, send sewage to places it shouldn't go, disrupt medical or prescription drug information or even affect safe operation of traffic lights, he said.

"The biggest concern that I have is a cyberattack that leads directly to a loss of life or multiple people losing their lives," Strand said. "There needs to be a prioritization of security across all government entities and health entities."

Minnesota water systems suffer cyberattack

On July 28, Minnesota officials announced that a "coordinated cyberattack" had targeted computerized operational systems at more than 30 municipal water systems in the state, disrupting processes in at least five communities.

The city of Braham, about 70 miles north of Minneapolis, told residents that the city water system was offline for about two hours on July 27 due to a "malicious cyberattack of computerized operating systems by unknown actors."

The city reported that the attack did not affect water quality and that the city was able to maintain uninterrupted service.

"This attack did not alter or cause any issue to the physical water plant or water quality or safety," the city said in a press release. "Rather, the attackers shut down the operating controls which shut down the well and water treatment plant, causing the city to provide water to residents with only water held in the water tower."

"I think we’re cannon fodder in the Iran war. It's like they're trying to send a message that they can attack us from halfway around the world."
– Bryce Austin, a cybersecurity expert and the CEO of TCE Strategy

No water quality issues or use restrictions arose as a result of the attack, the state said. The Minnesota IT Services (MNIT) department said it is working with a wide range of state and federal partners to investigate the attack and bolster security against future incidents.

"Cyberattacks against critical infrastructure require a coordinated, whole-of-government response," John Israel, MNIT assistant commissioner and state chief information security officer, said in a July 28 news release.

"This incident demonstrates why Minnesota has invested in strong cybersecurity capabilities and partnerships. Our response worked as intended, enabling agencies at every level of government to rapidly coordinate, contain the incident, and help prevent more serious impacts to critical services.”

Federal agencies raise increasing concerns

The South Dakota and Minnesota cyberattacks came amid warnings by a pair of federal agencies about the increased risk of cyberattacks on critical infrastructure systems, including local drinking water and wastewater systems.

In May, the U.S. Cybersecurity & Infrastructure Security Agency (CISA) warned that infrastructure systems that use programmable logic controller systems and which rely on the internet for communication or control were under increasing threat of cyberattack.

An updated CISA bulletin in July expanded the scope of the concern to "urgently warn U.S. organizations of ongoing Iranian-affiliated cyber targeting of internet-connected operational technology."

The advisory said attacks could occur "through malicious project file interactions and manipulation of data."

As far back as May 2024, the federal government issued warnings about potential cyberattacks on U.S. water systems and lax security systems in place at community water systems. An Environmental Protection Agency alert noted that attacks were likely to come from the Iran government's Islamic Revolutionary Guard and state-sponsored bad actors in Russia or China.

"Cyberattacks against (community water systems) are increasing in frequency and severity across the country," the EPA said at the time. "Based on actual incidents we know that a cyberattack on a vulnerable water system may allow an adversary to manipulate operational technology, which could cause significant adverse consequences for both the utility and drinking water consumers. Possible impacts include disrupting the treatment, distribution, and storage of water for the community, damaging pumps and valves, and altering the levels of chemicals to hazardous amounts."

The EPA said previous inspections found "alarming cybersecurity vulnerabilities at drinking water systems across the country" that included poor password usage, single login access to the system and failure to properly lock out former employees.

Vulnerabilities found in county governments

County governments in particular may be highly vulnerable to attack for a number of reasons, including a high amount of information held within systems that are often understaffed and may not have sufficient system protections in place.

A January 2025 article in the Journal of Cybersecurity drew upon a University of Maryland study that examined security risks at nearly 3,100 county governments in the U.S. – including those in South Dakota – and found worrisome gaps on cybersecurity.

County governments need greater cyber protection systems and improved employee processes because counties are often responsible for providing water, policing, education and elections, and possess significant personal and financial information about residents.

"The consequences of poor cybersecurity at the local level can be disastrous," the authors concluded. "Given their impact on society, documented gaps in county government cybersecurity are alarming," the authors wrote.

'Cannon fodder' in the ongoing war?

Both governments and private industry should expect more cyberattacks in the future as more public services and commerce are conducted online and through computer networks, said Bryce Austin, a cybersecurity expert and the CEO of TCE Strategy, a Minnesota-based firm that provides cybersecurity protection and compliance services.

The "one-two punch" of cyberattacks in South Dakota and Minnesota within the same month is concerning but not overly surprising, he said.

Several signs point to cyberattacks by Iran, which may be trying to make a statement as it continues to battle the U.S. in war, Austin said.

"I think we’re cannon fodder in the Iran war," he said. "It's like they're trying to send a message that they can attack us from halfway around the world."

"We better get used to it because this is the new normal."
– John Strand, owner of Black Hills Information Security

Russia tends to seek disruptions of American systems for political or military purposes while China often seeks intelligence that can help its economy or competitiveness in the global marketplace, Austin said.

Federal, state and local government agencies need to invest in stronger systems protections, employee training and larger IT workforces to potentially prevent future attacks, he said.

"You don’t need your county infrastructure to have perfect cybersecurity," Austin said. "It just needs to be significantly more difficult to hack than many other counties."

Strand, who launched his family-run company in his basement near Deadwood in 2008, has grown the firm to 160 employees who conduct 950 security assessments annually across the world.

He complimented Pennington County on how it has handled the security breach so far but said it would be a "tragic mistake" if the county doesn't release a full accounting of the attack and its response at some point.

"Just trying to hide it and bury it is almost always the wrong answer, and I'm hoping with these other breaches that we're seeing they will release information so that this can get fed back into the broader ecosystem, so everyone can learn," Strand said. "We better get used to it because this is the new normal."

South Dakota News Watch is an independent nonprofit. Read, subscribe for free and donate at sdnewswatch.org. Contact content director Bart Pfankuch: 605-937-9398/bart.pfankuch@sdnewswatch.org.

Yes.

South Dakota gubernatorial candidate Toby Doeden received a smaller percentage of the vote in the runoff against Larry Rhoden on July 28 compared to the Republican primary in early June.

Doeden received 31% of the vote when there were four candidates during the June 2 primary that also featured Dusty Johnson and Jon Hansen. In Tuesday’s runoff election, Doeden received 29%, and Rhoden won with 71%. Now Rhoden will meet Democratic candidate Dan Ahlers in the Nov. 3 general election.

Doeden led in just two counties during the runoff – Fall River and Todd – compared to 28 during the primary. He also lost his home county (Brown), where he secured 32% of the vote Tuesday.

The number of registered Republicans increased by about 7,300 since June 2, as some Democrats and Independents switched parties and new voters were added for the runoff. Those voters were expected to help Rhoden.

Sources

South Dakota Secretary of State’s Office, Runoff election results

KELO-TV, A surge of new Republicans eligible to vote in runoff

South Dakota News Watch, Did Larry Rhoden beat Toby Doeden in West River voting?

Ballotpedia, South Dakota gubernatorial election (2026)

About fact briefs

Fact briefs are bite-sized, well-sourced explanations that offer clear "yes" or "no" answers to questions, confusions and unsupported claims circulating online. They rely on publicly available data and documents, often from the original source. Fact briefs are written and published by South Dakota News Watch as part of the Gigafact network. Submit a question for us to answer on the tipline.

South Dakota News Watch is an independent nonprofit. Read, donate and subscribe for free at sdnewswatch.org. Contact freelance reporter Michael Klinski: michael.klinski@sdnewswatch.org.