In the southern Appalachians, disjunct red spruce (Picea rubens) populations persist at low latitudes at elevations above 1,370 m. However, research on the condition of these disjunct red spruce populations is limited. This study compares species composition, stem density, basal area, health, and recruitment in two of the southernmost red spruce populations in North America: the Alarka Laurel and Rich Mountain spruce bog basins in Nantahala National Forest, North Carolina. Moreover, using stand data collected at Alarka Laurel in 2007, we assessed changes in the stand and compared those data to our 2022 survey. Our findings revealed that red spruce was the dominant overstory species, comprising 24.3–25.9% of all measured overstory trees, with seedlings and saplings making up 51.0–86.2% of the red spruce population, indicating stable recruitment. Red spruce basal area declined by 48.2% from 2007 to 2022 in Alarka Laurel, with a concomitant increase in some hardwood species. However, both Alarka Laurel and Rich Mountain showed levels of sapling and seedling recruitment that were comparable to red spruce stands found in other regions. Overall, red spruce trees were healthy, particularly seedlings, representing the healthiest size category, determined through visual assessment. Our results, derived from a reassessment of Alarka Laurel and the addition of the Rich Mountain site, suggest that these stands are relatively stable but may benefit from modest management efforts that increase light availability in areas with dense evergreen shrub cover or that have an overstory dominated by red maple (Acer rubrum).