Kalawao County in the state of Hawaii is the smallest county in the United States by land area and the second-smallest county by population. The county encompasses the Kalaupapa Peninsula on the north coast of the island of Moloka’i, and the only access is a mule trail. Because of the small population — 79 as of 2023 — Kalawao County has no elected government and doesn’t have the same functions as other counties in the state. Instead, it’s a judicial district of Maui County, which includes the rest of the island of Moloka’i. Kalawao County was developed and used from 1866 to 1969 as a settlement for persons quarantined with leprosy. The quarantine policy was only lifted after effective antibiotic treatments were developed that could be administered on an outpatient basis and patients could be rendered non-contagious. Many of the residents chose to remain on the peninsula, as they believed their disfigurements from the illness would make reintegration into society impossible. The state promised they could live there for the rest of their lives. No new patients or other permanent residents are permitted to live there. Visitors over the age of 16 are allowed only as part of official tours. The county has a total area of 53 square miles — 12 square miles of land and 41 square miles of water.
