Three small incorporated towns, Warwick, Harmor, and Oberon, within the reservation boundaries have primarily Indian populations. On the north and west the reservation borders Devils Lake, North Dakota's largest natural lake, the southern boundary is the Cheyenne River. Land along the lake and river is forested, beyond this the area consists primarily of rolling prairie hills with high quality farm and pasture land. The area climate is among the most extreme in the continental United States with temperatures falling below 30 F in the winter and summer temperatures ranging between 70 and 100 F. Rainfall is moderate, roughly averaging 25 inches per year. Tribal low rent housing units, HUD homes, and mutual self-help homes exist in the four major reservation communities.
Rural farmsteads consist of privately owned homes and mutual help scatter sites.
IHS has few employee quarters, therefore, arrangements have been made to share existing BIA units with IHS and the Tribe. Rental and private purchase housing, within commuting distance from Fort Totten, are available in Devils Lake. In 1996, Tribal environmental staff identified the lack of a solid waste dump site as the major reservation environmental problem which may be hazardous to the health of reservation residents.