By the late 1940s, television had come to major metropolitan areas across the United States. Sets were expensive, reception unreliable, and audiences relatively small, but national broadcasting leaders continued to champion the new medium, and entrepreneurs in West Virginia were determined to bring TV to the Mountain State.

In 1948, the Federal Communications Commission granted approval for the construction of WSAZ television in Huntington. The television station, the 72nd in the nation and the first in West Virginia, was an affiliate of WSAZ radio station. WSAZ-TV went on the air October 14, 1949, as channel 5, becoming channel 3 in 1952. Early shows included the first telecast of a Marshall College (now University) basketball game on December 3, 1949.

Radio stations in Charleston, Parkersburg, and Wheeling soon followed the lead of WSAZ radio in bringing television to their markets. In Charleston, WKNA went on the air in 1953 as channel 49. In October of that year, WTAP (channel 15) began broadcasting in Parkersburg, and WTRF (channel 7) went on the air in Wheeling. The first Charleston station, however, proved unsuccessful. As a UHF channel, WKNA required its viewers to buy special equipment, and the terrain limited reliable reception to the downtown area. Rival WCHS had acquired a permit to construct VHF channel 8, which went on the air in August 1954 while WKNA went out of business.

Four more television stations began telecasting in the 1950s: WOAY (channel 4) in Oak Hill, December 1954; WHIS (channel 6), now WVVA, in Bluefield, July 1955; WOWK (channel 13), formerly WHTN, in Huntington, October 1955; and WBOY (channel 12) in Clarksburg, November 1957. The launch in June 1960 of WJPB (channel 5), now WDTV, serving Weston-Bridgeport-Clarksburg-Fairmont was followed by a two-decade hiatus. In February 1981, WLJY (channel 46) of Clarksburg began broadcasting and, in September 1982, WVAH (channel 11, formerly 23), started transmitting from Hurricane. Since that time, additional stations have gone on the air.

Public television made its debut in West Virginia in February 1969, when WWVU (channel 24), now WNPB, of Morgantown went on the air. WMUL (channel 33), now WPBY, of Huntington followed suit in July of that year; and, in November 1970, WSWP (channel 9) of Beckley began broadcasting.

Because of its rugged topography, West Virginia was a pioneering state in the early development of cable television. In late 1949 and early 1950, commercial cable installations began operating at Piedmont in Mineral County and Cameron in Marshall County, respectively. The first coaxial cable system started carrying programming of WSAZ television to Welch in 1951. For the same reason, West Virginia also figured in the early expansion of satellite television.

Reflecting their advertising strategy, West Virginia television stations in the 1950s began producing a variety of local programming aimed at children, teens, women, and other demographic segments. Especially popular were religious shows, "hillbilly" music jamborees, wrestling matches, and guest interview broadcasts. Among the memorable personalities and programs were Farmer Bill Click, Don Wagoner the "Beachcomber," and longtime news anchor Bos Johnson (WSAZ); Dick Reid's "Lucky 8 Ranch," Marilyn Fletcher's "Romper Room," Jackie Oblinger's "Women's Page" and Katie Doonan's "Katie's Kitchen" (WCHS); Bill Hickock's "Circle 6 Ranch" and Cecil Surratt's "R.F.D. Jamboree" (WHIS); Reverend Hoover's "Message of Light" (WDTV); "Uncle Pete"for kids (WBOY); Pat Gaughan's "TV 7 Reports"(WTRF); and versatile on-air talent Shirley Love (WOAY).

West Virginia Media Holdings owned four stations in the state (WOWK, WBOY, WTRF, WVNS) until 2017, when it sold all its holdings to Nextstar Media, headquartered in New York, Chicago, and Irving, Texas. Other leading stations are owned by out-of-state media companies such as Sinclair Broadcast Group of Baltimore (WCHS, WVAH) and Gray Television Group of Atlanta (WSAZ, WTAP, WDTP, WVFX, WVVA)). WOAY in Oak Hill is one of West Virginia’s few remaining television stations with local ownership: descendants of Robert R. Thomas Jr., who founded it in 1954.