Welch, the county seat of McDowell County, is located at the confluence of Elkhorn Creek and the Tug Fork. In 1858, the first county seat was situated at Perryville, and later it was moved to other towns. In 1892, 34 years after McDowell County was created, the county seat was located at Welch.

The local topography consists of steep hills, V-shaped valleys, and sharp ridges. Welch is tucked into this rugged terrain, with the town built on the narrow valley floor of the Tug Fork and its tributaries and less than 1,000 feet wide in places. In the early 1800s, the area was settled by hunters largely from central Virginia, eastern Kentucky, and western North Carolina. In 1873, industrialist Isaiah Welch, for whom the town was named, came to McDowell County to evaluate the natural resources of the area. He reported the existence of vast amounts of timber and numerous seams of quality coal throughout the Elkhorn and Tug Fork valleys.

The report stimulated a movement of coal entrepreneurs into the county, and by 1891 the Norfolk & Western (N&W) Railway Company had extended its line from Mercer County into McDowell County. Welch, the newly designated county seat, was situated on the main line of the N&W. In 1894, the 300-acre site was incorporated as the town of Welch, and in 1895 the courthouse was constructed. On August 1, 1921, the courthouse steps were the site of the assassinations of Sid Hatfeid and Ed Chambers, prompting the Armed Miners March on Logan and the Battle of Blair Mountain.

Entrepreneurs and mine barons quickly sought building lots in the town and constructed lavish dwellings on both bottomland and hillside lots. By the turn of the 20th century, mining towns were developing throughout the county, and Welch had become a service center for the coalfields.

Banks, stores, churches, schools, a newspaper office, and a hospital were established. The population of Welch grew steadily through the boom years of coal mining. In 1895, the estimated population was 300; by 1920, the population had risen to 3,232. By 1930, the population had increased to 5,376.

As the town had boomed with the coal economy, so it suffered with the regional downturn. The population of Welch peaked at 6,603 people in 1950 but fell to 3,590 in 2020 due to out-migration. The loss of mining jobs with the mechanization of the coal industry and the devastating floods of the late 20th and early 21st centuries, particularly the 2002 flood, contributed to the city's problems.

In March 2023, the Welch News, McDowell County’s only print newspaper, announced it was shutting down. Founded during the coal boom in 1927, it had reduced publishing from six to five days per week in 1975 and cut back to three days per week in 1995.

The Welch Commercial Historic District was added to the National Register of Historic Places in 1992.

Read the National Register nomination.