Global climate change poses significant risks to coastal and riverine communities. Managed retreat, the purposeful movement of people and infrastructure out of vulnerable floodplains, is one possible adaptation strategy. The USA has already engaged in a limited amount of retreat by providing federal funds to purchase and demolish or relocate vulnerable properties. As retreat programs are expected to expand in size and frequency to address the increased risks posed by climate change, a review of how such property acquisition programs have been implemented is timely. Specifically, decisions made by government officials regarding where to acquire properties have significant potential social justice implications, as buyouts could promote or reduce existing social inequities, but it is unclear how such decisions are being made. A review of eight US buyout programs suggests that buyouts, as practiced, lack transparency, which may increase public distrust of the process and reduce participation. Moreover, decisions often involve political motivations and rely on cost-benefit logic that may promote disproportionate retreat in low-income or minority communities, continuing historic patterns of social inequity. However, as low-income communities in the USA also tend to be highly vulnerable to climate-exacerbated hazards, a decision not to relocate may also promote disproportionate harm. The buyout programs reviewed provide examples of how to mitigate these concerns through increased transparency, emphasis on relocation, explicit focus on social inequality, longer-term and larger-scale holistic approaches, and participatory pre-disaster planning. Further research on past programs is needed to evaluate outcomes and processes to improve future adaptation efforts.