Increases in harvest of the American horseshoe crab (Limulus polyphemus) during the 1990s, particularly for whelk bait, coupled with decreases in species that depend on their eggs has reduced horseshoe crab abundance, threatened their ecological relationships, and dictated precautionary management of the horseshoe crab resource. Accordingly, population assessments and monitoring programs have been developed throughout much of the horseshoe crab’s range. We review and discuss implications for several recent assessments of Delaware Bay and New England populations and a meta-analysis of region-specific trends. These assessments show that the western Atlantic distribution of the horseshoe crab is comprised of regional or estuarine-specific meta-populations, which exhibit distinct population dynamics and require management as separate units. Modeling of Delaware Bay and Cape Cod populations confirmed that overharvest caused declines, but indicated that some harvest levels are sustainable and consistent with population growth. Coast-wide harvest was reduced by 70% from 1998 to 2006, with the greatest reductions within Delaware Bay states. Harvest regulations in Delaware Bay starting in the late 1990s, such as harvest quotas, seasonal closures, male-only harvest, voluntary use of bait-saving devices, and establishment of the Carl N. Shuster Jr. Horseshoe Crab Reserve, were followed by stabilization and recent evidence of increase in abundance of horseshoe crabs in the region. However, decreased harvest of the Delaware Bay population has redirected harvest to outlying populations, particularly in New York and New England. While the recent Delaware Bay assessments indicate positive population growth, increased harvest elsewhere is believed to be unsustainable. Two important considerations for future assessments include (1) managing Delaware Bay horseshoe crab populations within a multi-species context, for example, to help support migratory shorebirds and (2) anticipating the potential for harvest restrictions within Delaware Bay to redirect harvest onto outlying populations that cannot sustain the increased harvest.