The western United States is experiencing a severe multiyear drought that is unprecedented in some hydroclimatic records. Using gridded drought reconstructions that cover most of the western United States over the past 1200 years, we show that this drought pales in comparison to an earlier period of elevated aridity and epic drought in AD 900 to 1300, an interval broadly consistent with the Medieval Warm Period. If elevated aridity in the western United States is a natural response to climate warming, then any trend toward warmer temperatures in the future could lead to a serious long-term increase in aridity over western North America.