Oak Hill incorporated in 1905, late by the standards of the New River coalfield. The town grew around the intersection of several railroad spurs that fed the mines along Arbuckle Creek, in places like Minden, McKell, and Whipple. By the time the population peaked in the mid-twentieth century, Oak Hill had become the commercial center for a constellation of working coal camps. The mines closed, mostly, by the 1950s and 1960s. The town held on. Today the population is around 8,100, making Oak Hill the largest city in Fayette County, larger than the more famous Fayetteville just a few miles north. Most of the small-town fabric is still here: brick storefronts on Main Street, autumn corn-shock displays on Halloween, icicle lights at Christmas, the rhythms of an Appalachian county seat that survived its industrial era.

On December 31, 1952, Hank Williams left Knoxville, Tennessee in a Cadillac driven by Charles Carr, headed for a New Year's Eve show in Charleston, West Virginia, and a follow-up show on January 1 in Canton, Ohio. The Charleston show was canceled because of bad weather. Williams was in poor health, dosed with chloral hydrate and possibly morphine, by the time the Cadillac stopped at the Skyline Drive-In just south of Oak Hill in the early hours of January 1, 1953. Carr noticed Williams was unresponsive, drove to the Pure Oil station for help, and a doctor at Oak Hill Hospital pronounced Williams dead. The cause was listed as heart failure. A plaque on Main Street in downtown Oak Hill marks the city's place in country music history. Music fans still visit each January.

About five minutes outside Oak Hill, off WV Route 16, the small village of Minden sits in a hollow along Arbuckle Creek. It was a coal town founded in 1899 - some of the original company-built miners' houses are still there, packed close along narrow streets. The mines closed in the 1950s. Then in the 1980s, soil at the old Shaffer Mine site was found to be contaminated with PCBs at extraordinary concentrations, and the EPA designated the site as a Superfund priority. Residents have for decades documented a cancer cluster that scientists and federal agencies have studied repeatedly. The 2023 documentary Impossible Town brought national attention to Minden's situation. Visitors to Oak Hill often stop in Minden as a side trip. The advice from locals: drive slowly, the homes are close to the road, and children play in the streets.

Oak Hill sits at the southern doorway to the New River Gorge. Whitewater rafting on the New and Gauley Rivers is largely staged from Fayetteville a few miles north, but several outfitters operate from Oak Hill too. The town has the practical infrastructure that smaller Fayetteville lacks - a hospital, a Walmart, chain hotels, the kind of services that make it a base for visitors who want to spend their days in the gorge and their nights somewhere with reliable plumbing. From Oak Hill, Fayetteville is essentially next door on US 19. Beckley sits 20 minutes south. Summersville and Summersville Lake are about 30 minutes north. Charleston is about an hour west. Lewisburg, with its historic district and the nearby Greenbrier resort, is just over an hour east. The town is small. The places it connects to are not.