Originally known as Balize, Louisiana, Pilottown was settled about 100 years ago when traffic on the Mississippi river shifted from one channel to another.  This forced river pilots to abandon their station about five miles downriver.  Other people followed, attracted by the nearby National Delta Wildlife Refuge.  In the 19th and early 20th century, many pilots and their families lived here.  The peak population was likely reached in the 1860's, when Balize had a population of over 800 people.  The repeated devastation caused by violent storms and hurricanes caused most residents to relocate, and today the permanent population of Pilottown is less than 20 people.  Pilottown is not listed in the United States census figures.

The town now consists of a few buildings built on piers and connected by raised sidewalks.  Only the Crescent River Port Pilots’ Association has housing in Pilottown for their members on call.  Members of the Associated Branch Pilots who provide pilotage between the entrance to the Mississippi River and Pilottown abandoned their station after Hurricane Katrina in 2005.  The Branch Pilots moved their station up river approximately 10 miles to Venice, Louisiana despite their pilotage route begining at Pilottown.

Pilottown is accessible only by boat or by helicopter.  It is located in the swampy ground of the lower Mississippi River Delta, about 85 miles down-river of New Orleans (65 miles by air) and about 10 miles south of Venice, Louisiana.  It is just upriver from the point where the river splits into multiple branches.