Orthodox Christianity includes several national churches that are united with one another but not with the Roman Catholic Church. A main difference is that Orthodox Christians do not follow the Pope. In West Virginia, the main Orthodox groups are Antiochian, Carpatho-Russian, Greek, and Serbian, each with its own leadership.

Orthodox Christians first came to the U.S. in 1768 and began arriving in West Virginia around 1880, settling in coal towns and later in northern steel mill areas. Early believers met in homes, but they soon built churches and brought priests from their home countries.

The first Orthodox church in the state, St. Mary Carpatho-Russian, was founded in 1880. In 1892, Syrian and Lebanese immigrants started St. George Orthodox Church in Charleston, still the largest Antiochian church in the state. Greeks also started several churches.

While many small parishes closed, larger cities kept their Orthodox churches. As of 2023, there were 15 Orthodox churches in places like Charleston, Morgantown, and Wheeling.

In the late 1990s, Russian monks founded the Holy Cross Skete (a small monastery) in Wayne County. It is part of the Russian Orthodox Church Outside of Russia, which reunited with the main Russian Church in 2007.