This dissertation argues that conceptions of providence remained a significant force in eighteenth-century America and the Atlantic world. Major studies of the Enlightenment and secularization have focused on the declining influence of providential thought at this time, and there were indeed changes in the way that providence was imagined: the created world was construed in more mechanistic ways that required less divine intervention and posited a more substantial realm for human observation and action. But change is not the same as decline. Based on readings of published and manuscript sources in both English and German, this dissertation argues that belief in particular providence continued to shape how early American Christians—including Puritans, Congregationalists, German Pietists, Methodists, and Presbyterians—reflected on and responded to illness. The retrospective framework established by Christians’ reflections conveyed an earnest hope in God’s direction and intervention in the world and shaped, in turn, their endeavors in medicine, benevolence, and mission, and their responses to major social changes, including slavery. Belief in providence remained an enduring feature of American life; it connected the intimate experience of sickness to the intellectual arguments behind major political and social transformations.