Gristmills grind grain into meal, flour, and animal feed. Among the world's oldest industrial enterprises, they were an indispensable part of agricultural economy and community life from colonial times until the middle of the 20th century. These mills commonly used rough circular revolving stones, called "buhrs" or "burrs," to grind grain, although a few crushed the grain with rollers or hammers. Most were erected on streams and used overshot water wheels. These are the picturesque side wheels of the sort seen on the well-known mill at Babcock State Park in Fayette County.

Records of the Virginia Company show a water-powered mill under construction in 1621, although the first American gristmill on record was built in New Amsterdam (New York) in 1634. Fearing Indian attacks, settlers in Western Virginia were slow to build gristmills despite abundant water power, relying on hand mills or mortar and pestle to grind grain. However, a few mills go back to the earliest days of settlement. The oldest working gristmill in West Virginia is Shepherd's Mill at Shepherdstown, built by Thomas Shepherd between 1734 and 1739. The Bunker Hill Mill in Berkeley County, the state's only remaining tandem-wheel water mill, was constructed in 1737 but was later rebuilt and is no longer operational.

The turbine, invented in 1827, made water-powered mills more efficient although less photogenic. Blaker's Mill, now at Jackson's Mill in Lewis County, is turbine-powered. In the late 19th century, more modern sources of power began to be employed. The Easton Roller Mill in Monongalia County (1865) replaced its overshot water wheel and buhrs with steam power and rollers in 1894, milling up to a ton of flour a day. Howell's Gristmill in Wetzel County (1930) is powered by a 1912 gasoline engine, and French's Mill in Hampshire County (1911), a fully operational hammer mill, has converted to steam from electricity.

Gristmills have been a significant part of West Virginia's industrial and cultural history as well as notable features of its landscape for more than 250 years. In addition to providing meal and flour, they also served as meeting places where ideas and news could be exchanged. Although most of these mills are gone, some remain operational, and others, such as Reckart's Mill in Preston County (1865) and Cooper's Mill in Summers County (1869), are being restored.