But its rich history and Farrakhan's charisma have kept it firmly planted on the national stage. Whether it can maintain that presence without Farrakhan's leadership remains to be seen.
Farrakhan said he will be available to offer guidance should any major problems arise.
"In this period of testing, you can prove to the world that the Nation of Islam is more than the charisma, eloquence and personality of Louis Farrakhan," he said in the letter to his members.
Farrakhan, who visited Cuba in March, likened his illness to that of Cuban President Fidel Castro and said that just as Cuba did not fall apart without its long-term leader, neither would the Nation of Islam.
He also said he hoped to be able to "continue to serve because I do not believe that my earthly work is done."
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