West Virginians of all ages play sports, from youth soccer, softball, and basketball leagues, through the Senior Olympics. About 125 high schools compete annually in 19 championship events—10 boys, eight girls, and one co-ed (cheerleading)—under the control of the Secondary School Activities Commission (SSAC). Colleges and universities in West Virginia compete at five levels of National Collegiate Athletic Association competition. West Virginia University (B-12 Conference) and Marshall University (Sun Belt Conference) field teams at the NCAA Division I level.

Most of the state's smaller public and private colleges and universities competed in the 15-member West Virginia Intercollegiate Athletic Conference (WVIAC) from 1924 until it disbanded in 2013. The WVIAC played at the Division II (previously NAIA) level. Ten of the former WVIAC teams, plus two from out of state, are now part of the Division II Mountain East Conference. Bethany College competes in the Division III President’s Athletic Conference. West Virginia University Tech is a member of the NAIA-level River States Conference. Potomac State College of WVU belongs to the NJCAA-level Western Pennsylvania Conference.

Professional sports include minor-league teams in both baseball and hockey. Charleston, which has the state's richest tradition in baseball, is the home of the Charleston Dirty Birds, a member of the Atlantic League, an MLB Partner League. The Princeton WhistlePigs and Bluefield Ridge Runners are long-time rivals in the Appalachian League (for rising freshmen and sophomore college players). The West Virginia Black Bears, who play their home games in Morgantown, are part of the MLB Draft League. The Wheeling Nailers are a Pittsburgh Penguins affiliate in the East Coast Hockey League. Huntington formerly hosted two hockey teams: the Huntington Hornets (1956-1957) and Huntington Blizzard (1993-2000).

Organized sports began to develop in the United States between 1870 and 1920. The highlight event of that era in West Virginia was an 1880 bare-knuckle boxing match between Joe Goss, the recognized champion of America, and Paddy Ryan, the challenger. Boxing was illegal, and the fight was held in Colliers, a tiny railway village in Brooke County, which was easy to get to and get away from and conveniently close to two state lines. Ryan won the 86-round fight.

The first golf club in America was organized at Oakhurst near White Sulphur Springs in 1884. The club was established when a golf course was built on the estate of Russell Montague to entertain visiting Scottish friends. The club held Christmas Day championship matches for at least the next six years. Later, White Sulphur Springs remained the center of golf in the state when the famous Old White Course was built in 1913 on the grounds of the Greenbrier resort.

College football began in West Virginia in 1891, when the team from West Virginia University hosted Washington & Jefferson College of Pennsylvania. The visitors, coming by steamboat down the Monongahela River, defeated WVU, 72-0. By the early 1900s, almost every college in the state had a football team.

During the 1920s, the explosion of spectator sports and school sports nationally also was felt in West Virginia. Three colleges began to play a national football schedule. In 1919, WVU amassed an 8-3 record, losing in close games to Pitt and to the famous "Praying Colonels" of Centre College. WVU's Ira Rodgers became the first state player to be named to the All-America team. In 1924, West Virginia Wesleyan defeated such powers as Navy (10-7), Syracuse (7-3), and Kentucky (24-7). Davis & Elkins capped an excellent 1928 season with a 7-0 win over WVU and a 2-0 victory over Navy.

College and high-school competition became organized during the early 1900s. The SSAC began in 1916, although a basketball champion had been crowned since 1914, when Elkins beat Wheeling, 28-13. The segregated Black high schools of the West Virginia Athletic Union held their first tournament at West Virginia State College (now University) in 1924, with Wheeling Lincoln defeating Kimball 25-24 for the championship. The WVIAC began in 1924 and the following year named Marshall as the first football champion.

Minor league baseball solidified with the development of the "farm system" during the 1920s and 1930s. The Middle Atlantic League and the Mountain States League had teams in six West Virginia cities. Amateur baseball thrived in the smaller towns and coal camps, with teams sponsored by mines and other companies. The emergence of unions and the Depression began to cut into the number of teams.

During World War II and the post-war era, West Virginia prospered and sports peaked. In football WVU dominated the Southern Conference and played in the 1953 Sugar Bowl; Marshall played in the 1949 Tangerine Bowl; and Morris Harvey College (now University of Charleston) participated in four bowl games in the 1950s, including a Tangerine Bowl victory over Emory & Henry in 1951 and an Elks Bowl victory over East Carolina in 1954.

Several college basketball teams reached national prominence. The 1942 WVU team, led by Dyke Raese, won the National Invitation Tournament (then considered the premiere national tournament), defeating Western Kentucky 47-45 in the final game. Marshall, coached by Cam Henderson, won the National Association of Intercollegiate Basketball Championship in 1947 with a 73-59 win over Mankato College of Minnesota. West Virginia State College romped through an undefeated season in 1948, winning the regular-season and tournament championships in the segregated Colored Intercollegiate Conference. Earl Lloyd and Bob Wilson from that team were later among the first African Americans to play in the National Basketball Association. West Virginia State and Bluefield State integrated the previously all-White WVIAC in 1955. In 2004, the Mountain State University Cougars basketball team won the NAIA Division I national championship, defeating California's Concordia University, 74-70.

The 1950s and 1960s were the golden age of WVU basketball. Led by All-Americans Mark Workman (1952), Rod Hundley (1957), Jerry West (1958 and 1959), and Rod Thorn (1962 and 1963), the Mountaineers were a perennial Top 10 team. The apex occurred in 1959, when West led the Mountaineers into the NCAA finals against the University of California. Despite a heroic 28-point performance by West, WVU lost 71-70 in a heart breaker. Coach Gale Catlett took charge of Mountaineer basketball in the last quarter of the century, leading the team from 1978 until his retirement after the 2001-02 season. In 2010, under Bob Huggins, WVU made it back to the Final Four for the first time since 1959 but lost to Duke in the semifinals.

West Virginians were also prominent in golf during the 1950s. Sam Snead, the long-time pro at the Greenbrier, was a dominant player on the PGA Tour, winning 82 tour victories from 1936 through 1965, which still ties him with Tiger Woods for most all time. The 1964 U.S. Amateur Championship Final matched two West Virginia golfers. Bill Campbell of Huntington (a 15-time West Virginia amateur champion) beat Ed Tutwiller of Charleston (an 11-time West Virginia amateur champion) in the match play finals.

Individual athletes have stood out in worldwide competition ever since 1924, when West Virginians began competing in the Olympics. As of 2024, no West Virginian has won a gold medal in the Winter Olympics. The following have won gold medals in the Summer Olympics: Cornelius Louis Burdette of Sandstone, men’s team rifle (1912); Jerry West, men’s basketball (1960); Montgomery native Mike Barrett, men’s basketball (1968); Mary Lou Retton, the first American woman to win a gold medal in gymnastics (1984); Vicky Bullett, women’s basketball (1988); James Jett of Shenandoah Junction, track and field (1992), who would later become the fastest man in the NFL as a receiver for the Oakland Raiders; and Randy Barnes of Kanawha County, shot put (1996). Athletes associated with West Virginia University’s rifle teams have experienced remarkable success nationally and internationally. The following Mountaineers have won gold in Olympic rifle competitions: Jack Writer (1972); Ed Etzel (1984); Nicco Campriani, winning a gold medal for Italy in 2012 and two in 2016; and Ginny Thrasher (2016). WVU soccer player Kadeisha Buchanan won gold for Canada’s women's team in 2020. Dave Wottle, competing for Bowling Green State University, won gold in track and field (1972); he later became the track coach at Bethany College.

In 1972, federal legislation mandated school and college athletic programs for girls and women. By the late 1970s, school athletic programs doubled as women's teams were begun and the WVIAC and SSAC added championship events for women.

By the mid-1980s and the 1990s, college football in West Virginia became nationally competitive. In 1980, Don Nehlen was hired as the football coach at WVU. In 1988 and 1993, he had perfect 11-0 regular-season records. Although bowl losses to Notre Dame in the Fiesta and Florida in the Sugar eliminated national championship hopes, those seasons marked the reestablishment of WVU football in the annual Top 25 rankings. Don Nehlen retired as coach of the WVU Mountaineers in 2000. His last game was a victory over Mississippi in the Music City Bowl.

In 1970, a tragic plane crash killed almost all the Marshall football team and coaches in the worst air disaster in college sports history. From the ashes of the crash Marshall rose to dominate NCAA Division I-AA football in the 1980s and 1990s. The Thundering Herd played in seven national championship games, defeating Youngstown 31-28 in 1992 and Montana 49-29 in 1996 for national championships. In 1997, Marshall made the jump from Division I-AA to Division I-A, joining the Mid-American Conference (MAC). That year, led by Coach Bob Pruett, who has become Marshall's winningest football coach, the Thundering Herd became the most successful first-year I-A team in history with a record of 10-3. In the years since, Marshall won four straight MAC championships and three victories in the Motor City Bowl. Marshall was a member of Conference USA from 2005 to 2022 and won that conference’s football title in 2014. Since 2022, Marshall has competed in the Sun Belt Conference.

In the 2020s, two West Virginia schools have won national championships. In 2021, Marshall won the NCAA Division I men's soccer national championship. In 2022, Glenville State won the NCAA Division II women's basketball national championship.

e-WV presents West Virginia Public Broadcasting on WVU in the 2012 Orange Bowl: