Each year, the finest football players from West Virginia's northern high schools (including those in the Eastern Panhandle) come to Charleston to compete with their counterparts from southern high schools in the North-South Game. Each squad of 33 players includes many who go on to successful college sports careers, and some who make it to the National Football League. Among game alumni who have played in the professional ranks are Mike Barber and Walter Easley (both San Francisco 49ers), Rich Braham (Cincinnati Bengals), Carl Lee (Minnesota Vikings), Curt Warner (Seattle Seahawks), and Robert Alexander (Los Angeles Rams).

The first North-South Game attracted only a small crowd on New Year's Day, 1934, and ended in a scoreless tie. Charleston Gazette sports writer Frank Knight, who during the classic's 1940s and 1950s heyday was its biggest booster, called that first game "one of the greatest defensive combats in the history of scholastic sports in West Virginia." After the games were rescheduled for summer, under the lights at Charleston's Laidley Field, attendance soared.

The game was suspended from 1956 through 1975 due to an NCAA ruling on summer all-star contests and slumping popularity. Football great Sam Huff, who had played in the 1954 contest, helped revive it in the 1970s. As a vice-president of Marriott Hotels after his playing days, he enlisted the hotel chain to become a lead sponsor of the game.

Recent games have not been as well attended because of competing TV sport shows and other summer events, but West Virginia towns still have their high school football heroes, and the annual North-South classic remains a traditional and exciting showcase for them. Through 2024, the overall series stands at 42 wins for the South and 25 wins for the North, and three ties.

Since 1983, a North-South boys basketball game also has been played each year in the Kanawha Valley, except 1993, when the game was played in Paden City. As of 2024, South has dominated the basketball series, 31-9.

In 2020, both the football and basketball North-South games were canceled due to the COVID-19 pandemic.