Stacey Schulz parks in a rear lot to avoid the crowded Main Street entrances to her local pharmacy.
"During the summer, it's kind of hectic," she said after greeting the pharmacist and technician by name.
That's because Schulz's pharmacy is tucked inside Wall Drug, a tourist attraction that takes up almost an entire block and draws more than 2 million visitors a year to a community of fewer than 700 residents.
The business is named after the town of Wall, which is just off Interstate 90 near Badlands National Park. Colorful, hand-painted billboards dot the roadside for hundreds of miles, telling motorists how far they are from Wall Drug's free ice water, 5-cent coffee, and homemade doughnuts. Visitors can pan for gold, listen to singing animatronic cowboys, try on Western wear, and shop for souvenirs, including plush jackalopes — mythical jackrabbits with antelope horns.
Despite being part of a booming tourist attraction, Wall Drug's pharmacy faces challenges common to independent rural pharmacies.
It's the lone pharmacy in Wall, serving locals year-round. Some, like Schulz, live in town, while others live on ranches as far as 60 miles away. The next-nearest pharmacy is a 30-minute drive northeast.
Wall Drug also serves tourists who forget their prescriptions at home, get sick while roaming the country in their RVs, or hurt themselves while hiking through the otherworldly rock formations of the scorching Badlands, said Cindy Dinger, its sole pharmacist.
Wall has no hospital, but a clinic is open four days a week. Schulz, a medical assistant there, said she and her co-workers see a lot of summer tourists. They send them to Wall Drug to pick up prescriptions.
"And then we tell them to get fudge before they leave," Schulz said.
Rural pharmacies, especially independent ones, closed at a higher rate from 2003 to 2021 than pharmacies in other areas, according to a study by the Rural Policy Research Institute. By 2021, the institute found, nearly 8% of rural counties were left with no pharmacy. The Wall Drug pharmacy has fewer customers than a typical city pharmacy, which can mean less profit, Dinger said.
She said some of its prices are higher because the store can't negotiate discounts as steep as the deals suppliers grant chain pharmacies. Rural drugstores also lack leverage with insurers, and they face increasing competition from mail-order pharmacies.
Another challenge is staffing. When Dinger needs time off, she finds a fill-in from Rapid City, nearly an hour's drive away.
"It’s a challenge getting relief if I want to go on vacation or if I need a cover so that I can go to a doctor’s appointment," she said. "You take what you can get and try to schedule around it."
Dinger said her pharmacy would struggle without the rest of Wall Drug.
"All this stuff around us — the poster and print shop, the boot shop, the fudge shop, the café — they pay our bills," she said.
The pharmacy's white facade, with stained-glass signs and windows, is modeled after that of the original drugstore, which was across the street. The window displays and top shelves inside the store are filled with vintage pharmacy supplies, including manuals, glass medicine bottles, and a suppository-making machine.
Tourists carrying shopping bags and sporting new cowboy hats stop to look at the displays. "It's a real pharmacy," a woman said, sounding surprised.
Dinger and Sylvia Smith, the store's only pharmacy tech, ring customers up below a Tiffany-style light fixture and retrieve prescriptions stored behind a wooden desk and wall.
Customer Will Lovitt said a friend advised him and his wife to stop at Wall Drug during their drive from Indiana to the Black Hills in western South Dakota. Lovitt developed a rash on the trip and ended up using the visit to get Dinger's advice on treating it.
He said it can be difficult for tourists to know where to find medical help, especially when driving through rural states like South Dakota.
"I think it's time that America gets back to the grass roots of the small-town doctor and the small-town pharmacist," Lovitt said.
Alex Davis and a friend decided to visit Wall Drug on their road trip from Kansas to Yellowstone National Park.
"Then, when I saw there was a little pharmacy, I thought I’d grab something that I needed," she said.
Davis bought Dramamine to treat car sickness on the long drive.
Dinger said she occasionally sees unusual situations, like the time several years ago when a park ranger needed antibiotics after getting bitten by a prairie dog.
"You never know what kind of diseases they might be carrying," she said of the animals, which recently were hit with an outbreak of plague.
Rick Hustead is the chairman of Wall Drug. The store was opened in 1931 by his grandfather, pharmacist Ted Hustead. Ted's wife, Dorothy, had the idea to advertise its soda fountain and free ice water to tourists traveling along unpaved roads during the hot years of the Dust Bowl era. Rick's father, pharmacist Bill Hustead, began expanding the store in the '50s, turning it into the tourist magnet it is today.
Rick Hustead didn't follow his father and grandfather's path to pharmacy school, so he had to recruit pharmacists from elsewhere.
Hustead found Dinger in 2010 after writing a letter to each pharmacist in the state.
Dinger said she was living at the time in Sioux Falls, South Dakota's most populous city. But she and her husband were interested in raising their kids in a small town, the way she grew up. Dinger was also attracted by the store's limited hours: She'd be done working by 5 p.m. on weekdays and have the weekends off.
Hustead said his family has never considered closing the pharmacy, even though it's not the main attraction for most visitors.
"We can’t be Wall Drug without being a drugstore," he said.
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 This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF - the independent source for health policy research, polling, and journalism.
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