Medicine Hole occupies a striking landscape in the Badlands region of western North Dakota, approximately twenty miles south of Theodore Roosevelt National Park. Designed by Jim Engh and opened in the early 2000s, the course takes its name from the natural geological feature known as Medicine Hole, a deep, water-filled sinkhole that has long held significance in the area's cultural history. Engh, known for his dramatic use of natural terrain and bold design features, routed the course through rugged Badlands topography characterized by exposed rock formations, native grasses, and significant elevation changes. The layout showcases Engh's signature style of integrating golf holes into dramatic landforms rather than imposing conventional design upon them. Players navigate through coulees, around rock outcroppings, and across terrain that reflects the raw character of the northern Great Plains. The course offers expansive views of the surrounding Badlands and requires thoughtful club selection given the elevation changes and wind exposure typical of the region. Medicine Hole serves as a public facility in a sparsely populated area of North Dakota, providing a distinctive golf experience in a part of the country not traditionally associated with destination golf. The course represents an example of modern design philosophy that emphasizes working with extreme natural features rather than flattening or softening them, making it a notable outlier in the regional golf landscape.