Fungal pathogens can regulate the abundance and distribution of natural plant populations by inhibiting the growth, survival, and reproduction of their hosts. The abiotic environment is a crucial component in host–pathogen interactions in natural plant populations as favorable conditions drive pathogen development, reproduction, and persistence. Foliar plant pathogens, such as fungal lesions referred to generically as “leaf spot disease,” are particularly responsive to increased moisture levels, but the manner in which the abiotic environment drives disease dynamics, and how these diseases regulate natural plant populations, is not fully understood. We investigate (1) the impact of ambient soil moisture and diffuse light on the prevalence of a leaf spot pathogen (Phyllosticta sp.) in a natural population of Polygonatum biflorum, an understory herb native to deciduous forest understories in the eastern US, and (2) the effects of the fungal pathogen on the survival, growth, and abundance of the plants. We tracked six P. biflorum populations and disease incidence, as well as soil moisture and diffuse light, between 2003 and 2005 in the understory deciduous forest of the southern Appalachian Mountains, North Carolina, USA. Results show that both the occurrence of P. biflorum and the prevalence of P. biflorum leaf spot disease are highest where soil moisture is intermediate and diffuse light is lowest. Disease occurrence depends upon plant presence, but it also adversely impacts plant survival, abundance, and growth. These results suggest that leaf spot disease is likely to impact population dynamics, which in turn vary as a function of environmental drivers.