West Virginia's land surface rises to its highest elevations in the Allegheny Mountains and Yew Mountains (a subsidiary range of the Alleghenies), which occur in the northeastern and east-central areas of the state. The highest point (4,861 feet above mean sea level) is Spruce Knob, along the crest of the Allegheny spine in Pendleton County. Most of the state's rivers begin among these high mountains. The lowest elevation in the state (247 feet) occurs at Harpers Ferry at the eastern tip of the Eastern Panhandle, where the Potomac River leaves West Virginia. To the west, the lowest elevation (approximately 620 feet) is reached at Kenova (near Huntington), the westernmost part of the state, where the Ohio River passes on to Kentucky and westward.

West Virginia is nicknamed the Mountain State because of the rugged, mountainous terrain that comprises essentially all of its area. However, the state's topographic character varies in direct association with its geology. The Eastern Panhandle lies in the Ridge and Valley province, a name that aptly describes the local topography. Long, steep, narrow, northeast-southwest trending mountain ridges are separated by relatively broad, flat-bottomed valleys. The wide, flat to gently rolling Shenandoah Valley lies in the easternmost part of the Ridge and Valley province, and extends into the northeastern part of West Virginia, culminating at Harpers Ferry.

The western boundary of the Ridge and Valley topography is distinctly marked by the Allegheny Front in the north (Mineral, Grant, and Pendleton counties), and by the St. Clair Fault in the south (Monroe and Mercer counties). Whereas most topographic boundaries within the state are transitional, this one is sharp and abrupt. Immediately west of the Ridge and Valley province is the Appalachian Plateau province, including a High Plateau sub-province. A belt of relatively broad, more massive mountain ridges makes up the High Plateau region, and includes the state's highest elevations. The High Plateau encompasses Preston, Tucker, and Randolph counties, and parts of Mineral, Grant, Pendleton and Pocahontas. The mountains exert significant influence on the weather of the region. As the typical weather pattern moves from west or southwest to east across West Virginia, the gradually rising western slope of the High Plateau induces rainfall, and receives the highest rate of precipitation of any place in the state. Conversely, the low-lying valleys just east of the abrupt Allegheny Front lie in a "rain shadow" of the high mountains, and receive the least precipitation in the state.

The western two-thirds of West Virginia lies in the Appalachian Plateau, but substantial differences in topography exist from north to south and from east to west within this province. The east-west variation is simply a transition from the broad mountains of the High Plateau to the gently rolling, small hills adjacent to the Ohio Valley. The north-south variation is less systematic. The northern part of the state exhibits broad rolling hills with often steep, narrow stream hollows. Total surface relief (the difference in elevation from highest hilltops to deepest hollows or valleys) is typically on the order of several hundred feet. The configuration of the land surface imposes relatively little restriction on residential placement, and hilltops and ridgelines are often the settings of choice for domestic and business development.

In contrast, the southwestern part of the state (south and southwest of Charleston, in particular) has extremely rugged topography. This deeply eroded plateau exhibits narrow, winding valleys and hollows and narrow, sharp-crested ridges, with very steep slopes. Total relief commonly exceeds 1,000 feet. Cultural development is largely confined to the tight valley floors and floodplains in this area, which includes the state's rich southern coalfields.