Our objective was to evaluate the prevalence rate of Helicobacter pylori (HP) in children from urban and rural areas of West Virginia. In all, 1164 blood samples were collected from children who attended a local health fair, pediatric clinics, and emergency departments of four different hospitals located in urban and rural counties. Socioeconomic status was determined in 303 children. Serum HP antibody (IgG) was measured by enzyme immunoassay (EIA). A total of 468 (40%) samples were HP positive. HP acquisition correlated with increasing age, family crowding, and community location (urban/rural) but not with gender, water source used (city/well), or socioeconomic status. The prevalence rate of HP in the children of West Virginia is higher than any data previously reported from the United States. The results correlated with only few socioeconomic criteria, suggesting that other factors may contribute to the increased prevalence of HP infection in the children of West Virginia.