The island is inhabited by one of the region's oldest English-speaking communities, which is known for its relic accent, preserving speech patterns from the original English colonial settlers.
The community is located in a small town-area in the central part of the island, and is also called Smith Island, the northern part of which is the Martin National Wildlife Refuge within the state of Maryland, and the southern part of which lies in Accomack County, Virginia.
The Island has been shrinking in size for centuries, due to a combination of its low elevation and storm erosion. In the last 150 years, Smith Island has lost over of wetlands due to erosion and post-glacial subsidence into the Chesapeake Bay. To prevent the island from being lost to erosion, restoration efforts will be ongoing for the next 50 years to restore of submerged aquatic vegetation and of wetlands.
Smith Island has no land bridges and so people traveling there can only access it by boat. Passenger-only ferries connect Smith Island at Ewell to Solomons, Maryland, on the Western shore of the Chesapeake Bay and from Crisfield, Maryland on its Eastern Shore.
On its Maryland side, Smith Island is a census-designated place (CDP) in Somerset County, Maryland, United States. It is included in the Salisbury, Maryland-Delaware Metropolitan Statistical Area.