Individuals of Italian extraction constitute one of the most important ethnic groups in West Virginia's population. Most of these Italian-Americans date their connection with the state to ancestors who were recruited during the early years of the 20th century to serve the labor needs of West Virginia's rapidly developing industrial economy. With more than 17,000 Italian immigrants in the state by 1910, they made up 30 percent of West Virginia's foreign-born population. In fact, so many Italians had entered the state that for over a decade before the First World War, the Italian government maintained a consular office in northern West Virginia to look after them.

The influx produced important enclaves of Italian immigrants throughout much of West Virginia. Most of these population concentrations were located in six counties in the northern part of the state, with Marion County leading the way, followed by Harrison, Tucker, Randolph, Preston, and Monongalia. At the same time, significant clusters of Italians were also drawn to southern West Virginia. McDowell County, with 2,300, could boast the most Italian immigrants in the state in 1910, although the Fayette County communities of Boomer, Harewood, Longacre, and Smithers constituted the greatest single concentration of Italians in the state.

While immigrants were attracted to West Virginia from all over the Italian peninsula, the majority came from that country's southern regions of Campania, Calabria, and Sicily. Many of the Sicilian immigrants came from the center of that island and were fleeing the depressed conditions in the sulfur mining industry. The region of Calabria, at the "foot" and "ankle" of the Italian boot, produced even more emigrants. So many Calabrians came from such communities as San Giovanni in Fiore, Cacurri, and Caulonia that they constituted the core of the Italian population in both the northern and southern sections of the Mountain State.

The great majority of Italian immigrants were employed in the coal industry as pick-and-shovel miners. West Virginia mines were among the most mechanized in this country, but miners born in America or northern Europe generally operated the new machines and usually earned better money, while their counterparts from less favored regions did the handwork. Despite this disparity and the fact that many such immigrants were kept hopelessly in debt by unscrupulous coal companies, West Virginia Italians were able to significantly improve their financial position.

In part, the Italians achieved real economic progress and acceptance by the sheer dint of hard labor. The records for coal production by hand tools are all apparently held by Italians. For instance, in 1924, Carmine Pelligrino of Rosemont in Marion County mined 66 tons of coal in one 24-hour period and earned the nickname "Sixty-six" (later shortened to "Sixty"). Eleven years later, Dominic Fish (formerly Pesca) of Boomer mined by hand 48 tons of coal in one day and 52 tons the next at the Union Carbide mines at nearby Alloy.

Italian miners in West Virginia also improved their economic position by self-sacrifice and frugality. Raising livestock and tending gardens kept down expenses and helped to produce some prodigious savings relative to their income. The U.S. Department of Labor reckoned that such Italian miners sent more money back to their home country than any other comparable group of immigrants.

Although large numbers were involved in digging coal, West Virginia's Italians were an occupationally diverse group. Even in the coal camps, they often held a variety of jobs such as teamsters, carpenters, blacksmiths, shoemakers, stonemasons, and laborers. In many places, Italians were a vital part of the business community. The occupational diversity of Italians was especially notable in the northern part of the state where urban industrial settings were more common. For instance, historian William Klaus has shown that Italians in Marion County were not just miners, but also worked in glass and other manufacturing establishments, on railroads, in skilled trades, on farms, and in their own small businesses. The same could be said for the substantial groups of Italians who labored in the mines and mills of Wheeling, Weirton, and other Ohio River valley industrial centers.

While many Italian immigrants eventually left West Virginia, many others stayed and made a long lasting impact on the state and its institutions. Italian union members and organizers such as Tony Stafford and Armando Folio helped to make the Mountain State one of the most union-oriented states in the nation. West Virginia Catholicism and its ancillary institutions have been strengthened considerably by the infusion of Italian parishioners. The continuing influence of Italians in West Virginia is symbolized by the growth of the yearly Italian festivals held in the state at Clarksburg and Wheeling in the north and Bluefield and Princeton in the southern part of the state. As late as 1970, Italians with at least one parent born in the old country constituted West Virginia's second-largest ethnic group.

By the third generation, Italians had moved into the center of political life in many parts of the state. In 2005, Joe Manchin became West Virginia's first governor of Italian descent. His uncle A. James Manchin, secretary of state and treasurer, had preceded him as one of the state's most popular politicians.