PIERRE, S.D. — South Dakota since 2018 has fallen six places in an annual report ranking all 50 states, from number 14 in 2018 to 20 in 2019.

U.S. News and World Report on Tuesday, May 14, released its annual Best States report, which ranks each state based on eight main categories.

South Dakota ranked 20 this year, lower than the majority in the region. Minnesota snagged the title for third-best in the country, then Nebraska was ranked number 9, Colorado 10, Wisconsin 11, Iowa 14 and North Dakota 15. Montana and Wyoming ranked lower than South Dakota at 29 and 31, respectively.

Of U.S. News' eight primary categories on the state's "scorecard," South Dakota received the highest marks for its natural environment and fiscal stability, which the report named the second- and third-best in the country. On the other end of the spectrum, South Dakota's crime and corrections grade was 40, and its opportunity grade was 34.

Health Care: 32nd place

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In the report's most heavily weighted category, South Dakota's health care was ranked 32nd in the country. The state's quality of health care was ranked number 43.

Measured by children's and adults' wellness visits, insurance enrollment and affordability of care, South Dakota's health care accessibility was rated 26th.

Per the report, fewer South Dakotans are uninsured than the national average, with South Dakota's uninsured rate at 12.8%, compared to 13.8% nationally. The state's rates of obesity and preventable hospital admissions are slightly higher than the national average.

Education: 18th place

Education in South Dakota was ranked 18th in the country, with higher education taking 10th place and Pre-K through 12th grade number 23. The state's high school graduation rate is less than one percentage point lower than the national average.

South Dakota college students graduate with more debt than their peers elsewhere; the average South Dakotan graduating with over $31,000 in student loan debt compared to the national average of approximately $29,000.

Economy: 27th place

South Dakota's economy ranked 27th in the country, with its business environment ranking 45th, employment at number 12 and growth at 23.

According to the report, the state's rate of job growth at 0.5% is lagging significantly behind the national average of 1.2%.

Colorado's economy was named the best in the country.

Infrastructure: 16th place

The state's infrastructure was rated 16th-best in the country. The state came in third place for energy infrastructure, measured by renewable energy usage, reliability of power grids and the average cost of electricity.

Per the report, 37% of South Dakota's total energy use comes from renewable sources, compared to the national average of 10%.

South Dakota didn't perform as well in internet accessibility, rated at 43 in the country according to how many South Dakotans have access to broadband and "ultra-fast" internet.

South Dakota's transportation was ranked 33 in the country, with the state's average commuting time nearly 10 minutes shorter than the national average. While fewer South Dakota roads were deemed in poor condition than the national average, the state's bridges were ranked 47th. The state's public transit usage was also in the bottom three, at number 48.

North Dakota's infrastructure was ranked fifth-best.

Opportunity: 34th place

Opportunity in South Dakota was ranked 34th in the country, with the cost of living and poverty rate both slightly lower than the national average, and overall affordability ranked number 14. Neighboring state Iowa was ranked number one in affordability.

Per the report, South Dakota's average household income is lower than the national average, at approximately $57,000, compared to $60,000.

Within the opportunity grade, South Dakota was rated last in the country in equality, as measured by the ratio of genders represented in the workforce, as well as pay disparities between them. The equality grade also measures the unemployment rate of disabled people versus able, and educational, financial and employment opportunity gaps between races.

Although the report shows that South Dakota has a sizable female workforce, it also shows that many of South Dakota's working women earn less than males, with the state ranking 43rd in the nation for income gaps between genders.

And for people of color, South Dakota's grades are even more harrowing: South Dakota was ranked worst in the country for income gaps and employment gaps between races, and 46th for education gaps by race.

Opportunity in Minnesota and North Dakota were ranked third- and fourth-best.

Fiscal Stability: 3rd place

U.S. News deemed South Dakota the third-most fiscally stable state in the country, with short-term fiscal stability coming only behind Florida and long-term stability in eighth place. The state has a AAA credit rating, a hallmark achievement of former-Gov. Dennis Daugaard.

Crime and Corrections: 40th place

South Dakota's public safety, weighted on both violent and property crime rates according to 2017 FBI data, was rated 21st in the country (with a higher ranking denoting a lower crime rate).

The state's corrections system was rated 48th in the country, based on its incarceration rate, juvenile incarceration and racial equality in jailing.

South Dakota's violent crime rate was higher than the national average, and juvenile incarceration rate double at 200 juveniles incarcerated per 100,000, compared to 100 per 100,000 nationally.

Natural Environment: 2nd Place

South Dakota earned top honors for its natural environment, beat only by Rhode Island in first place and followed by Minnesota in third place. The state ranked third in the country for low pollution, with 85 pounds of toxins per square mile compared to the national average of 1,015.

South Dakota has 171 days per year with unhealthy air quality, compared to the national average of 227. The state's environment grade was docked, though, for its water quality, with a higher-than-average number of drinking water violation points.