The University of South Dakota Physician Assistant Studies Program (USD PA Program) is in its 26th year of operation. The mission remains the same: to provide "a comprehensive primary care education that prepares graduates to deliver high-quality health care to meet the needs of patients in South Dakota and the surrounding region." The inaugural class graduated in 1995 making the class of 2018 our 24th. Graduates now number 462. The purpose of this article is to provide a brief historical background and to describe the evolution of the program and its contribution to the health care workforce of South Dakota and the region.