Before the welfare reforms of the New Deal, county farms, also known as county infirmaries or poor farms, played a major role in the care of people who because of poverty, infirmity, or old age were unable to care for themselves. Early West Virginia law followed Virginia precedent, making counties responsible for care of the poor. At first, county governments appointed overseers of the poor, who were to see that the indigent received adequate care. Most counties found that the overseer system worked haphazardly and turned to the establishment of a county farm, where any person in need might live in the county's care. The farms were operated by caretakers appointed by the county courts, usually on the basis of bids. Although the overseers continued to have general responsibility for the poor, the county farms provided the chief means of public support.

In the 1920s, county welfare boards replaced the overseers of the poor, and the state began to play a greater role in indigent care, establishing agencies to see to the welfare of children and veterans. Private agencies such as the Salvation Army, Red Cross, and Community Chest also helped. As unemployment grew with the coming of the Great Depression, however, both public and private agencies were swamped with the rising demand for assistance, and county farms designed to care for a few became crowded with many victims of the hard times. At the Kanawha County farm, for example, nearly 300 adults and children crowded into a building built in the 19th century to house 75 people.

As families disintegrated during the Depression, hundreds of children ended up in the crowded county poor farms, where they often had to share sleeping quarters with older adults and adults with mental illnesses. In 1933, shocked by press revelations of the desperate conditions, Maj. Francis Wheeler Turner, director of the state department of public welfare, set up temporary camps to rescue children from the poor farms and proposed to replace the county farms with regional farms operated by the state. Turner's plan proved abortive as welfare reform moved in other directions. The federal Works Progress Administration helped Mercer County experiment with a new kind of county farm that used family cabins rather than a single common dormitory. Other New Deal reforms, however, especially Social Security, led to the creation of a social welfare system that made the institutional housing of the poor a thing of the past. Most county farms soon closed, although some continued until the last residents died or moved out in the 1960s.