The role of tropical Pacific SSTs in driving global medieval hydroclimate is assessed. Using fossil coral records from Palmyra Atoll, tropical Pacific sea surface temperature (SST) boundary conditions are derived for the period 1320–1462 A.D. These boundary conditions consist of La Niña-like mean state conditions in the tropical Pacific with inter-annual and decadal variability about that altered state. The reconstructed SSTs in the tropical Pacific are used to force a 16 member ensemble of atmospheric general circulation model (AGCM) simulations, coupled to a one layer ocean model outside of the tropical Pacific. The AGCM simulations of medieval climate are compared with modern climate simulations for the period 1856–2005 A.D. and are shown to reproduce many aspects of medieval hydroclimate found in paleo-proxy records for much of the Western Hemisphere, northern Eurasia, and the northern tropics. These results suggest that many features of global medieval hydroclimate changes can be explained by changes in tropical Pacific SSTs, though the potential role for other oceans is also discussed.