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1North Dakota recently rose to the top of the list of new COVID-19 cases per person.
2North Dakota is one of the least populated areas in the United States, with only 700,000 people calling it home.
3It has had 40,000 cases statewide, with more than 6,000 active infections.
4"The state has a problem we haven't been able to solve yet," Travis Enders told VOA.
5Enders owns a business in Medora, a small tourist town in western North Dakota.
6The town's 112 people have resisted wearing face masks in a state long known for resisting government requirements.
7"North Dakotans are a different breed," said Jim Bridger, who owns a hotel and bar.
8"We live in lots of open space... socially distanced our whole lives."
9North Dakotans, Bridger said, do not like being told what to do.
10While he requires workers at his hotel to wear masks, he does not have the same rule at the bar.
11He keeps the seating distanced and cleans the business each night.
12Jennifer Morlock, another North Dakotan, is of a different opinion.
13She believes that the longer the state takes to require masks, the longer the rise in COVID-19 cases will continue.
14Morlock owns a store that sells bicycles.
15Her bicycle shop is one of the few businesses in town that requires masks to be worn.
16"People like to talk about freedom and liberty," she said, adding "to me, freedom means the freedom to keep my business open. If I get sick, I don't have that freedom. I'll have to shut down."
17Medora has avoided the worst of an outbreak that is filling North Dakota's hospitals.
18That has saved the local economy, but possibly increased health risks.
19Enders noted that many visitors to world-famous Yellowstone National Park in Wyoming often go to North Dakota to visit Theodore Roosevelt National Park.
20They usually travel through Medora, which has reported an increase in tourists this year.
21Because of the COVID-19 health crisis, many vacationers are avoiding crowded seaside communities and other places traditionally popular among tourists.
22They are, however, visiting national parks in large numbers.
23"People are coming here because things are open and because they feel safe here," Enders explained.
24"The only time you really see a mask is when you walk into Walmart. That's about it."
25Health officials in the U.S. capital, Washington, D.C., have repeatedly asked people to cover their face, but wearing masks is less accepted in rural areas.
26Now, states that refused to require masks may be suffering the consequences.
27Those following COVID-19 cases note that neighboring South Dakota held a 460,000-person motorcycle rally in August.
28The event is now widely considered to have been a super-spreader activity.
29Even so, many people believe that increased testing is the reason for the rise in the number of cases.
30"Even in our little town, we have free weekly testing," Bridger said.
31"When you increase testing, you're more likely to find cases...and that's happening all over the state."
32North Dakota Governor Doug Burgum has left enforcement of safety measures to business owners.
33Early on, however, he did order the state to restrict businesses when the pandemic first reached the United States.
34A short time later, tourists stopped coming to Medora.
35North Dakota can get bitterly cold during the winter.
36People do little traveling, and the national park's visitors stop coming.
37Businesses earn most of their money between April and September.
38"So, it hurt when we had to stay closed during the first weeks of spring," Bridger said.
39In addition to tourism, the state's oil industry has struggled during the pandemic.
40North Dakota is the second largest oil manufacturer in the United States.
41As international travel stopped, the demand for oil collapsed.
42Before the coronavirus reached the United States, North Dakota's oil industry employed as many as 55,000 workers.
43They captured 1.5 million barrels of oil each day from the Bakken, an energy-rich rock formation that extends through the western part of the state.
44Today, 80 percent of North Dakota's oil operations are shut, and thousands of industry employees have been sent home.
45With the return of warmer weather, many Medora businesses reported a busier year than normal.
46"We saw more people than usual visiting the area," said Morlock about her bike shop.
47"I think with the national park, they feel like parts of North Dakota can be a safe place to travel that they've never been before."
48Others, like Enders, however, believe the increased number of tourists brought health risks.
49"It's great for business, but it's also a little bit of a worry," he said, adding "that means they're...bringing the virus with them."
50I'm Susan Shand.