A pharmacist shortage, mail and internet competition, thinning margins, and third-party payer issues are some of the issues challenging community pharmacies. Those challenges have raised concerns about the long-term viability of independent community pharmacies, especially those in rural areas. In addition to a pharmacy's role in the delivery of prescription drugs, community pharmacies also play an important role in the state and local economies, again, especially in rural communities. Community pharmacies consistently have been classified as a business that provides essential services. Because of the issues and challenges facing community pharmacies and their role as an essential service, this study was undertaken to quantify the economic contribution North Dakota's community pharmacies make to the state's economy and to examine community pharmacies' business characteristics, services provided, and other issues. This study estimates all relevant expenditures and returns associated with North Dakota's community pharmacies.