Although its overall prevalence is decreasing, leprosy continues to be a major cause of neuropathy worldwide. In the United States, it is a relatively rare condition. As a result, physicians may lack familiarity with the disease, which can delay diagnosis and treatment. Leprous neuropathy is characterized by involvement of dermal nerves and superficial peripheral nerve trunks in cooler body regions. A continuing pattern of immigration from endemic areas may allow practicing neurologists in any region of the country to become involved in the care of patients with leprosy. The diagnosis should be considered in patients from endemic regions presenting with peripheral neuropathy with or without skin lesions. Readily available diagnostic testing, access to subspecialists, and modern transportation and information systems through the satellite clinics of the Hansen's Disease center serve as major advantages for the management of leprosy patients in the United States.