Despite the extensive network of moisture-sensitive tree-ring chronologies in western North America, relatively few are long enough to document climatic variability before and during the Medieval Climate Anomaly (MCA) ca. AD 800-1300. We developed a 2300-yr tree-ring chronology extending to 323 BC utilizing live and remnant Douglas-fir (Pseudotsuga menziesii) from the Tavaputs Plateau in northeastern Utah. A resulting regression model accounts for 70% of the variance of precipitation for the AD 1918–2005 calibration period. Extreme wet and dry periods without modern analogues were identified in the reconstruction. The MCA is marked by several prolonged droughts, especially prominent in the mid AD 1100s and late 1200s, and a lack of wet or dry single-year extremes. The frequency of extended droughts is not markedly different, however, than before or after the MCA. A drought in the early AD 500s surpasses in magnitude any other drought during the last 1800 yr. A set of four long high-resolution records suggests this drought decreased in severity toward the south in the western United States. The spatial pattern is consistent with the western dipole of moisture anomaly driven by El Niño and is also similar to the spatial footprint of the AD 1930s "Dust Bowl" drought.