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North Carolina's Foothills region is the part of the Piedmont closest to the Appalachian ranges in the western part of the state. It shares many features in common with the Piedmont region—even its name (Piedmont is nothing more than the French for "foothill")—but also with the Mountain region to the west, making the Piedmont something of a hybrid area.

Some of the states largest urban areas are located here, including the largest city, Charlotte, to the south, and the "Triad" of Winston-Salem, Greensboro, and High Point farther north. Between them is a land of rolling hills and small towns. Some of them, such as Lexington and Thomasville, developed into major manufacturing centers for furniture and textiles during the 19th century. Another, Mount Airy, became world famous through its fictional avatar: Mayberry, Andy Griffith's affectionate tribute to the town of his birth.