During World War II, the Air Medal was to be awarded for a lesser degree of heroism or achievement than required for the Distinguished Flying Cross. However, many Army Air Force units began to award the Air Medal on a quota basis, e.g., 20 missions equaled one Air Medal or an Air Medal for every enemy aircraft shot down. Some commands carried this to extremes by awarding a DFC for every five Air Medals. By the end of the war, over a million Air Medals were awarded (many of which were oak leaf clusters). While this might appear extreme, the generous award of the Air Medal provided combat aircrews a visible sign that their devotion and determination were appreciated by the country. The Air Medal helped keep morale up in a force that suffered the highest casualty rate of the war after the Infantry.

The Air Force ceased all noncombat awards of the Air Medal with the institution of the Aerial Achievement Medal in 1988 but without a comparable peacetime medal, the other Services still award the Air Medal under circumstances not involving actual combat