Rural ambulance services in South Dakota are having an increasingly hard time recruiting volunteers and generating revenues, putting the stability of the services at risk and making it more likely that rural residents will endure longer response times in emergencies or possibly lose ambulance service altogether. While most larger cities in South Dakota have professional ambulance services or fire departments with paid staff members, rural services rely mostly on volunteers. In recent years, those rural providers have seen fewer people willing to volunteer and those who do volunteer are older residents who are aging out of the workforce. About a third of rural ambulance directors in South Dakota said they couldn’t respond to a call because of staffing shortages, according to a 2016 survey. Roughly a third more said response times were delayed due to lack of staffing.