Prenanthes boottii is a perennial herb that is endemic to the high elevations of the New England region in the U.S.A. There are twenty occurrences that are clustered into 6 isolated locations in New York, New Hampshire, Vermont, and Maine, ranging in size from over 25,000 individuals to a just few plants. While the global population size is over 120,000 individuals, nearly 90% are found in the vicinity of Mt. Washington. This species is found only in fragile, easily impacted, alpine environments. Most of the known occurrences are found at popular high elevation sites for recreational activities (hiking, camping). While the species appears to be stable, there are a number of low to moderate level threats across most occurrences including drought, recreation, competition with more aggressive species, exotic species, road/parking area maintenance, and climate change. This species meets the requirements for Vulnerable under criterion B for area of occupancy (AOO <500 km²), a continuing decline in the quality of habitat, and presence at six locations.

Prenanthes boottii is restricted to the highest peaks of the northeastern United States in Maine (Boundary Bald Mountain and Mt. Katahdin), New Hampshire (Mt. Washington and Mt. Eisenhower in the Presidential Range), New York (Adirondacks), and Vermont (Mount Mansfield and Camel's Hump). There is a false report from Quebec, Canada. In the White Mountains, there are two extant occurrences in Maine and eight in New Hampshire. There are six occurrences in the high peaks of the New York Adirondack Mountains and four in the Green Mountains of Vermont. There is a historical occurrence in Maine that has a questionable identification. Despite multiple attempts, plants haven't been seen since 1991. The occurrences are found in 6-7 isolated areas.

An incomplete census in 2014, estimated a global population of 129,280 individuals based on counts of flowering stalks or basal leaves when flowers were absent. Sayers (1989) found that mature Prenanthes typically have 3-5 basal leaves but the 2014 census counted each basal leaf as an individual. With the findings of Sayers (1989), the 2014 census is reinterpreted to show a potential minimum of 27,945, assuming mature plants have 5 basal leaves, and maximum of 44,834 individuals, assuming mature plant have 3 basal leaves. Almost 90% of the species global population is in New Hampshire, in the vicinity of Mt. Washington (Haynes 2014).

Prenanthes boottii is found in a variety of alpine habitats including moist tundra lawns, streamsides steep cirque ledges and crests, cliffs, and disturbed alpine sites such as trailsides and hut areas (Rawinski 1986). It is restricted to elevations above 1,000 m, which include only the highest peaks in the northeastern United States. Most of the sites are above the treeline, but the plant has been found occasionally well below treeline (Zika 1992), on open ledges. Plants tend to be found in somewhat exposed situations, as well as disturbed areas such as fell-fields, steep slopes, ravines and streamsides. It is also found in human disturbed sites.

Plant associates include Diapensia lapponica, Salix uva-ursi, Rhododendron lapponicum, Campanula rotundifolia, Potentilla tridentata, Juncus trifidus, Vaccinium uliginosum, Empetrum nigrum, Cornus canadensis, Carex bigelowii, Solidago cutleri, Minuartia groenlandica, Carex brunnescens, Hierochloe alpina, Woodsia glabella, Asplenium viride, Poa fernaldiana, Agrostis borealis, Abies balsamea, Mitella nuda, Solidago randii, and Aster acuminatus.
Prenanthes boottii reproduces both vegetatively and sexually, and in fact may use both methods of reproduction simultaneously. Vegetative reproduction is accomplished by means of root offshoots produced from the secondarily thickened parent roots. These offshoots eventually break off from the parent roots and produce new plants.

Plants flower in late summer (early July to early September). Sexual reproduction occurs through both self fertilization and outcrossing with a variety of insects serving as pollinators (Tetreault and Burgess 2019 in Haynes 2019). Seeds are set in mid September, and are wind dispersed. High winds and updrafts can carry the seeds long distances up to 10 km, but potentially up to 40 km (Haynes 2019). It is unknown what percentage of young plants are produced sexually as opposed to vegetatively.

The main threats to this species are related to recreational use of the mountain summits on which it occurs. Threats include trampling and disturbance by hikers (many populations are located close to hiking trails), and perhaps trail maintenance, over-collecting by botanists or picking by hikers, proximity to auto road (New Hampshire), drought, and possibly winter camping. Disturbance may be beneficial to the species, but that degree and frequency to have a positive impact is not known. The alpine environment is fragile, easily impacted, especially in wet weather, so the impact of disturbance may be more severe in different seasons. At some sites, the species is being outcompeted by native graminoids and shrubby vegetation.

Long term threats to this and other alpine species and communities include atmospheric pollution and climate change, either natural or anthropogenic. While little is known at present about these threats, they cannot be underestimated. One study found that this species may be negatively impacted by climate change due to decreased recruitment but also found that the species is likely capable of long distance dispersal, providing some ability to establish in more favourable habitats under a changing climate (Haynes 2019, 2021). Later life stages are believed to be more tolerant of climate, due to greater functional trait plasticity but population monitoring should continue as decreased recruitment could cause declines (Haynes 2021).

This species occurs in Alpine Garden Research Natural Area (U.S. Forest Service land) and on state park land in New Hampshire. In Maine, one site is in a state park, another is on public reserved land, and both are registered critical areas. Both populations in Vermont occur on state park lands. Populations in New York are located within a state park and Adirondack Park. It also occurs on U.S. Forest Service Land.
Monitoring of this species should continue and efforts should include documentation of threats, site condition, and abundance of plants. Ideally, habitat protection should be provided for all the alpine summits on which the plant occurs. However, some populations were identified as potentially high priority because they contain a unique genetic make up. They include the following subpopulations: Baxter, Hamlin, Alpine Garden, Armstrong, and Wright (Haynes 2019). Because the plant may move around within alpine areas, all the habitat in which the plant may occur (all areas above treeline as well as open ledges to 500 feet below treeline) should be protected. Protection by ownership is not likely to be the most effective means of protection. Instead, conservation organizations and landowners should enter into management agreements which allow for 1) moving trails away from populations of this and other rare plants; 2) monitoring and research; 3) adequate signage; and 4) daily patrolling of trails by naturalists during the summer hiking season.