When the plant was put on the federal list of Endangered and Threatened Plants in 1989, there were only 24 known populations, distributed across eight counties. Now the number of documented populations has increased to 119, across 10 North Carolina and three South Carolina counties. Of those 119 populations, 28 have more than 1,000 plants, and several are found on protected lands. 

The dwarf-flowered heartleaf (Hexastylis naniflora) is a perennial member of the birthwort family. It is a small plant, rarely growing taller than six inches high, with dark green, heart-shaped leaves that grow from an underground stem. Its flowers are small, beige to dark-brown, and found at the base of the leafstalk. 

Dwarf-flowered heartleaf is known from Cherokee, Greenville, and Spartanburg counties in South Carolina and Alexander, Burke, Caldwell, Catawba, Cleveland, Gaston, Iredell, Lincoln, Polk, and Rutherford counties in North Carolina. Typical habitats include moderate to dry bluffs, slopes, or ravines in deciduous forests, or moist soils adjacent to creeks, stream heads, or along lakes and rivers.

Dwarf-flowered heartleaf grows in urban areas, including Charlotte, NC; Greenville/Spartanburg, SC and Hickory, NC. As a result, habitat loss due to development has been the single largest threat to the plant. Other threats include invasive plants and encroachment of native woody plants.

Biologists modeled three scenarios, each reflecting a different level of conservation effort and habitat loss from development. Even in the high-development scenario, 56 populations would have moderate or better viability, with 28 of those having very high viability. 

Although its range includes rapidly developing areas of the Carolinas, since its listing, numerous organizations have come together to help protect several sites. 

In North Carolina:

• Duke Energy protects one of the largest known populations at its Cliffside Stream station in Cleveland/Rutherford counties, with an estimated population size of nearly 40,000 plants.
• Through the acquisition of rights-of-way and mitigation, the North Carolina Department of Transportation has protected many sites. Some they still own, and some are now managed by other organizations for conservation, such as the Broad River Greenway.
• The Nature Conservancy and Foothills Conservancy each hold a conservation easement conservation easement
  A conservation easement is a voluntary legal agreement between a landowner and a government agency or qualified conservation organization that restricts the type and amount of development that may take place on a property in the future. Conservation easements aim to protect habitat for birds, fish and other wildlife by limiting residential, industrial or commercial development. Contracts may prohibit alteration of the natural topography, conversion of native grassland to cropland, drainage of wetland and establishment of game farms. Easement land remains in private ownership.
  
  Learn more about conservation easement protecting a large population.

In South Carolina:

• The National Park Service conserves a population at Cowpens National Battlefield.
• The state of South Carolina protects two populations within its heritage preserve systems, one at Peters Creek Heritage Preserve, the other at Blackwell Heritage Preserve.
• South Carolina’s largest population, with more than 19,000 plants, is protected by Catawba Lands Conservancy as part of Rhyne Preserve.
• Area non-profits Naturaland Trust, South Carolina Native Plant Society, and Upstate Forever have also worked to conserve the species.