Recently, the transition to free market systems in many formerly socialist countries in Eastern Europe has led the leaders of North Korea to reevaluate the prospects for a socialist regime. Economic reforms in North Korea would change its urban growth and regional development to be more compatible with the current global economy. In this circumstance, understanding the relationship between urban changes and regional balance in North Korea is important for forecasting how North Korean urban and regional development would proceed. This article examines this relationship, testing regional balance through analyzing urban changes at the State, province, and city level from 1945 to the present. Information about population at these three levels is used to test the degree of regional balance in North Korea. At each level these tests prove that urban changes did not lead to the balanced development of regions. Instead, most of the population increase and industrial development have occurred in the vicinity of Pyongyang, while the other regions have experienced slower growth or even reduced levels of development.