Thirty natural populations of American ginseng (Panax quinquefolius L.) were censused twice annually for five to 11 years to monitor the rate, frequency, and intensity of root harvest. Over this period, 43% of populations were harvested and ca.10% of plants was removed by harvesters. On an annual basis, 15% of populations were harvested and 1.3% of individuals were confirmed harvested. Both rates are likely underestimates of actual rates since we used conservative criteria to recognize harvest. Nearly half of the harvested populations were harvested more than once. Harvesters removed a small proportion of plants from populations; however, they frequently took non-reproductive and small plants, making the effect of harvest more destructive. In addition, violations of regulations regarding season, location, and plant size were common (20%, 65%, and 82% of events, respectively). Only 6% of harvest events were legal and 1.4% of plants were legally harvested in all three respects at the study sites. Two illegal harvests were documented carefully because they occurred at or near census points. These harvests highlighted the proximal factors that result in unsustainable harvest practices: (1) removal of adult plants prior to ripening of seeds, thus precluding the proper planting of propagules for population recovery; (2) removal of plants that are under the legal size limit, with no ability of dealers or buyers to detect this violation; and (3) removal of plants from land in which harvest is strictly prohibited, and the associated difficulty of enforcing such rules. We discuss policy options that could contribute to addressing these problems.