I think it depends on how you define "healthy" here in SD, we have one REAL world beater, SVB. (He is seldom here, and mostly somewhere else, so...) Other than him, there are a few decent guys but probably only a handful of guys that you could begin to consider a "short stop" With a certain fellow from eastern Iowa moving back home, Danny Olsen is now the strongest player in the state by quite a bit, but still far from "pro"
That being said, there are a thousands of league players, and the only game in town for 95% of those is bar box 8-ball. Almost NO 9' tables in an actual pool hall. I can count all of them on one hand here in Sioux Falls. Taking that into count, I would say there are 30-50 players in the state that can play most/all games (1P, 8,9,10-ball, banks, etc.) at a decent level, me not being one of them, but learning fast to balance my game.
With all of the above taken into consideration, I would say that pool here is healthy in quantity, but not huge in quality. I think that is because we have a lot of bar go'ers that turned into "pool players." On a side note, if you run a Triathlon tournament, bean bags, darts, pool, or any three bar games. I think you would be hard pressed to find a stronger state.
I would think Las Vegas, or New Orleans, (Buffalo Billiards, The Worlds Pool Hall, LOL, is located.) is probably the pool hot spot right now.
best,
Justin