This chapter examines the US approach to North Korean human rights issues since the 1980s and argues that while the situation was afforded greater rhetorical attention during the Trump administration, his approach did not in fact substantively differ from that of previous presidents. In his North Korea policy, Trump sought the headlines and did what he could to appear to be shaking things up. In practice, however, not much changed. He was subject to the same concerns and values and external forces as his predecessors. As a result, US policy toward North Korean human rights continued to follow a familiar pattern: Human rights issues are raised only when relations between the US and DPRK deteriorate.