Butternut (Juglans cinerea L.) trees are being extirpated from their natural range by an epidemic caused by a fungal pathogen. Widespread mortality is reminiscent of past epidemics on American chestnut (Castanea dentata (Marsh.) Borkh.) and American elm (Ulmus americana L.). Butternut has remained relatively understudied, resulting in unsampled areas and gaps in our understanding of this forest epidemic and the future outlook of this species in North America. The previously unsampled area consisting of the northeastern United States was surveyed for the presence of J. cinerea, and several population health metrics were recorded, including recruitment, disease pressure, and hybridization. A total of 252 butternut trees were sampled. Analysis indicates that there is insufficient J. cinerea recruitment to maintain population sizes. Further compounding low recruitment, butternut saplings demonstrate elevated levels of disease impact from the fungal pathogen Ophiognomonia clavigignenti-juglandacearum Broders & Boland. Natural hybridization of butternut with introduced congenics such as Juglans ailantifolia Carrière is strongly associated with lower disease impact. Hybrid trees displayed an average of 2.4 cankers per tree compared with 4.5 cankers for nonhybrid butternut. Further niche and resistance studies are required to assess whether butternut hybrids can replace butternut in a natural setting. It still remains uncertain whether tree size or habitat affect disease impact; however, smaller trees, often residing in riparian habitats, were found to have a greater number of cankers. The data presented here, combined with past studies, provide critical information for use in butternut management strategy plans.