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Background: A lack of health coverage at athletic competitions and practices poses concern over the knowledge coaches have in providing adequate health care to high school (HS) athletes. Therefore, the purpose of this study was to determine the need for education of coaches in the prevention, assessment and management of sports-related injuries in South Dakota (SD)., Methods: Survey link e-mailed to 1,050 HS athletic head coaches in SD; 247 (23.5 percent) completed the prospective, web-based survey., Results: Of the respondents, 74.91 percent reported HS enrollments less than 300, with 79.36 percent in rural/frontier counties and 28.74 percent in medically underserved areas. Coaches from 14 sports responded. The majority indicated they were responsible for the immediate medical care of athletes at practices (89.07 percent) and competitions (74.90 percent); and 79.76 percent of coaches agreed or strongly agreed they needed more injury management education. Results also indicated less than 50.00 percent had current certifications in CPR/BLS (46.65 percent) and first aid (47.4 percent)., Conclusions: Due to the demand placed on head coaches to be the initial caregivers for injured athletes, there is a need for increased education of SD coaches related to the management of acute sports injuries. Additionally, policy changes may be indicated to address the lack of medical personnel available during HS athletic competitions and practices.