The research presented here explores why a few people left their valley-dwelling neighbors to build and live at El Pueblito on Cerro de Moctezuma, the only hilltop settlement constructed during the Casas Grandes Medio period (A.D. 1200-1450) in what is today northwest Chihuahua, Mexico. These people also constructed the only currently recognized trails to a settlement, a massive rock agricultural system and subterranean oven, and an unparalleled crowning hill summit precinct. Comparative analyses of artifacts from limited excavations at El Pueblito to four other Medio period settlements shows that in terms of ceramics, chipped stone, and ground stone, El Pueblito was an ordinary residence. However, other evidence demonstrates that El Pueblito, and more comprehensively Cerro de Moctezuma, was beyond the ordinary. Wood preference, bird wings, remains of elk, an impractical use of construction materials, an imposing use of buildings, a unique architectural style, and an untypical settlement composition support a conclusion of specialized, ideological interests. Trails and wayside shrines at Cerro de Moctezuma were physical and symbolic places that initialized perceptions of the hill. Theories of ritualization, architecture, pilgrimage, and community; ethnographic analogy; and archaeological parallels provide vantages to orient Cerro de Moctezuma within a broader ritualized landscape of interactions involving hilltop shrines, feasting ovens, ball courts, and Paquimé, the premier capital of Medio times. Cerro de Moctezuma and Paquimé each concentrated the trappings of specialization. Tangible reproductions of ritual in the hinterland, such as ovens and ball courts, are less elaborately expressed than at Paquimé. Likewise, hilltop ritual facilities are most elaborate at Cerro de Moctezuma compared to those in the hinterland. Pilgrimage to both ritual centers as well as hinterland ritual leaders are envisioned. Within a trans-regional ideology and worldview of hill settlement and use, Cerro de Moctezuma was locally crafted from a ritual mandate to reinforce and maintain central beliefs and values emanating from Paquimé and was a physical and ideological part of that great center with ritual leadership residing periodically at both places.