Fifty-seven West Virginians have received the Medal of Honor since its creation by act of Congress on July 12, 1862, during the Civil War. The Medal of Honor is awarded for bravery above and beyond the call of duty to members of its military and naval forces. It is the highest award for heroism bestowed by the United States.

Medals of Honor were awarded to 24 West Virginians for deeds of heroism performed during the Civil War, at battles in places such as Vicksburg, Mississippi, and Petersburg and Sailors Creek, Virginia. Some sources cite as many as 38 or 39 medals awarded to West Virginia soldiers during the war; however, these additional men resided in other states but served in West Virginia-based regiments. Most of them were members of the First West Virginia Cavalry, which included many recruits from Ohio and Pennsylvania.

Benjamin C. Criswell earned his medal at the Little Big Horn River, Montana, with Custer's 7th Cavalry in 1876. John Henry Quick received his for heroism at the Battle of Cuzco, Cuba, on June 14, 1898, during the Spanish-American War. The record of Mountain State valor continued through the Philippine and and Mexican campaigns, with a total of five recipients. Antoine (Tony) Gaujot received his medal for actions during the Philippine Insurrection. His brother, Julien Gaujot, received his medal for actions in Agua Pieta, Mexico, in 1911. Hugh Frazer, Henry Nickerson, and Lawrence Sinnett earned their medals at Vera Cruz, Mexico, in 1914.

Robert Cox and Claud Jones received their medals for noncombatant heroism aboard U.S. Navy vessels in efforts to save them from sinking. No West Virginian was awarded the Medal of Honor during World War I, although Chester West, a medal recipient, is buried in Mason County.

Eleven West Virginians earned Medals of Honor in World War II, including three in France (Bernard Bell, Stanley Bender, and Junior Spurrier); three in Germany (Clinton Hedrick, Jonah Kelley, and Walter Wetzel); two on Iwo Jima (Justice Chambers and Woody Williams); one in the Philippines (Melvin Mayfield); and one in the Solomon Islands (Herbert Thomas). Robert Femoyer was severely wounded while flying over Germany on November 2, 1944, but flew his crew safely back to Great Britain. He died shortly after being removed from the plane.

West Virginians Darwin Kyle, Cornelius Charlton, Ralph Pomeroy, and William Shuck were awarded the Medal of Honor for their actions during the Korean War.

Nine West Virginians were awarded the Medal of Honor following the Vietnam War, but only one lived to receive his medal. These men paid the supreme sacrifice to earn the nation's top military honor. Thomas Bennett was the first conscientious objector to receive the Medal of Honor. He refused to carry a weapon but served in the army as a medic, and was killed by gunfire while rescuing a wounded soldier.

Charles Rogers of Fayette County earned the Medal of Honor for his actions during a battle near the Cambodian border on November 1, 1968. Although wounded, Lieutenant Colonel Rogers directed artillery fire until the enemy force was repelled. He was awarded the medal at a ceremony at the White House on May 14, 1970. He is the highest ranking African-American to receive the medal.