RiverStone Health, a multi-jurisdictional health service district, serves Yellowstone County, which is home to approximately 142,348 people (15 percent of all Montanans). Officially, RiverStone Health is considered an urban health department and faces public health issues similar to larger cities such as homelessness, sprawl, crime, and access to healthcare. However, the area outside of the city of Billings is home to nearly 1/3 of the county’s population. This area is considered rural (42,000 residents). For rural Yellowstone County, different challenges are faced including sparse population and distance from care. Rural residents routinely travel between 40 and 200 miles to obtain services including medical care. 

The square mileage of Yellowstone County is 2,635 square miles with a population density of 49.1 persons per square mile. In Yellowstone County, approximately 24.2 percent of the population is under 18 years old with 6.9 percent being less than five years old. Persons aged 65 years and older comprise 13.8 percent of the population. Yellowstone County citizens are 91.8 percent Caucasian, 5.1 percent Hispanic or Latino, and 4.1 percent American Indian and Alaska Native persons.