The status and trends of issues related to the conservation of orchids native to the United States, Canada, and Greenland are considered. We focus on nine of the 16 Targets of the Global Strategy for Plant Conservation (GSPC). The first two targets, which all other targets rely upon, appear to have been adequately achieved, in addition to Target 11. Limited progress has been made on six other GSPC targets. Three case studies of efforts to conserve the native threatened orchids, Platanthera leucophaea (Nutt.) Lindl., Isotria medeoloides (Pursh) Raf., and Tolumnia bahamensis (Nash) Braem, are presented to demonstrate the difficulties as well as the issues associated with effective conservation. We describe our efforts to establish an international program to conserve all native orchids in the United States and Canada. The North American Orchid Conservation Center (NAOCC) is an internationally focused effort that is based on public-private partnerships. The goal of NAOCC is to conserve the genetic diversity of all native orchids through efforts to develop an international collection of seeds and orchid fungi. The NAOCC also focuses on the cultivation of all native orchids in an international network of botanic gardens, and they partner with private and public landowners to develop techniques to conserve and restore all native orchid species.