[8] Hot Springs is located in Fall River County at the southern edge of South Dakota's Black Hills.

According to the United States Census Bureau, the city has a total area of 3.61 square miles (9.35 km2), all land.

[10] The Sioux and Cheyenne people had long frequented the area, appreciating its warm springs.

According to several accounts, including a ledger art piece by the Oglala Lakota artist Amos Bad Heart Bull, Native Americans considered the springs sacred.

The town is also a gateway to the attractions of the southern Black Hills, particularly Wind Cave National Park.

[17] The Angostura Reservoir, a 4,407 acres (17.83 km2) lake is located 10 miles southeast of the city and is a popular fishing, camping, and recreation area.

A concerned group of veterans and citizens organized a "Save the VA" Campaign; they have countered the VA's proposal based on the results of multiple Freedom of Information Act requests, getting as far as meeting with Secretary of Veterans Affairs Eric Shinseki to show how they believe VA leadership manipulated data to justify the proposed closure of the Landmark.

After the Veterans Health Administration scandal of 2014, Hot Springs was visited by members of the United States House Committee on Veterans' Affairs for a Congressional field hearing regarding the proposed closure and the committee heard testimony from members of the Save the VA Committee and others opposed to the closure, as well as two VA administrators in favor of the closure.

Owing to its location in an area particularly prone to chinook winds, Hot Springs is one of the warmest places in South Dakota, with an annual mean temperature of 48.6 °F (9.2 °C).

Thirty afternoons each winter stay below 32 °F or 0 °C, with all but seven in the severe month of January 1937 not topping the freezing point.

Snowfall averages 31.1 inches or 0.79 metres – vastly less than the extremely snowy high parts of the Black Hills – due to the very dry winters and relatively warm temperatures.

Spring is usually the wettest season, especially in its later stages, due to occasionally very heavy thunderstorm rains.

Summers are generally hot, at times uncomfortably so, although mornings tend to be fairly comfortable.

The fall season is usually dry and sees increasingly variable temperatures: the first freeze can be expected as early as September 23, but maxima in the eighties Fahrenheit have occurred as late as November 8 (in 1999).