Asylum on the Hill is the story of a great American experiment in psychiatry, a revolution in care for those with mental illness, as seen through the example of the Athens Lunatic Asylum. Built in Southeast Ohio after the Civil War, the asylum embodied the nineteenth-century “gold standard” specifications of moral treatment. Stories of patients and their families, politicians, caregivers, and community illustrate how a village in the coalfields of the Hocking River Valley responded to a national impulse to provide compassionate care based on a curative landscape, exposure to the arts, outdoor exercise, useful occupation, and personal attention from a physician. Although ultimately doomed by overcrowding and overshadowed by the rise of new models of psychiatry, for twenty years the therapeutic community at Athens pursued moral treatment therapy with energy and optimism. Ziff’s fresh presentation of America’s nineteenth-century asylum movement shows how the Athens Lunatic Asylum accommodated political, economic, community, family, and individual needs and left an architectural legacy that has been uniquely renovated and repurposed for the present day.