The store would accept the paper wallet, import the private key and sent the money to a safe address (for which only he has the private key).
When it turns out that there was no previous double spend, the store can be sufficiently at ease that the money will arrive.
The customer would now present a second paper wallet from which he only shows the address (and keeps the private key secret). The store could then sent the correct amount of change from its own wallet. Both transactions would be unconfirmed, but for small amounts it should not be an issue.
However, without internet access the customer would have to trust the store that the change was actually sent as promised.