Located along the old Coös Trail through Dixville Notch, it first opened just after the Civil War as the Dix House, a 25-room summer inn established by George Parsons. In 1895, it was purchased by Henry S. Hale, a Philadelphia inventor and industrialist who had been a regular guest. He renamed it The Balsams, and over time enlarged and augmented the facilities. In 1918, Hale completed the Hampshire House, the towering wing which doubled the resort's capacity to 400 guests.

The Ballot Room of The Balsams is where Dixville Notch's presidential primary votes are cast just after midnight on the day of the New Hampshire primaries. These votes cast by Dixville Notch residents are among the first to be cast, counted, and reported nationally.