Severe drought is arguably one of the greatest recurring natural disasters that strikes North America. A synthesis of multiproxy data shows that North America was in the grip of a severe centennial-scale drought during medieval times (800–1300 AD). In this study, the Community Atmospheric Model (CAM) is used to investigate the role of sea surface temperature (SST) anomalies from the North Atlantic and the tropical Pacific Ocean on this megadrought. These anomalies are obtained from proxy reconstructions of SST. Four model experiments with prescribed SST anomalies in the tropical Pacific and/or North Atlantic Ocean were made. The CAM results captured the major dry features that occurred during medieval times in North America. The cold tropical Pacific alone can simulate essentially the drought intensity, while the warm North Atlantic alone can simulate the drought areal extent. The two working together can explain the severity and longevity of the drought. During the spring season, the cool tropical Pacific, or the warm North Atlantic, or both, results in less moisture transport to the High Plains, with a 15–40% decrease in rainfall. The importance of the Atlantic Ocean on medieval drought in North America suggests that attention should be paid not only to the tropical Pacific Ocean but also to the North Atlantic Ocean in understanding the North America drought variability and predictability, both at present and during the past. This is especially true because the Pacific Ocean SST anomalies in medieval times as recorded by proxy data are somewhat controversial, while the North Atlantic anomalies seem more certain.