Randall had never finished higher than sixth place at the Winter Games, dating to her first Olympics back in 2002 in Salt Lake City - a string of 18 attempts, counting Wednesday's start.
Americans Jessica Diggins and Kikkan Randall, the only mom athlete on Team USA, made history on Wednesday by winning gold in the women's team sprint cross-country event at the 2018 Winter Olympics in Pyeongchang, South Korea.
Sweden took home the silver medal and Norway won the bronze.
Diggins collapsed after crossing the finish line, and Randall rushed over to her teammate, embracing her as she lay exhausted on the snow. Koch's silver came 42 years ago at the Innsbruck Games.
This story will be updated.
"Hearing it out loud, it still doesn't feel real", Randall told NBC after the conclusion of the race.
"In the final stretch I was just thinking, "Go, go, go, I'm giving it everything I had and I've got someone who I really love and care about waiting for me at the finishing line and I just want to make her proud", she said of Randall.
Diggins came to PyeongChang peaking at the right time.
The race paired Diggins, who has won more world championship medals than any US cross-country skier in history, with Randall, the veteran whose success made the Americans contenders after years of futility.
Discussing her strategy, Diggins said that she wanted to push the pace early, to try to take some energy from the sprinters she was up against.
They beat runner-up Sweden.