While some 18th-cent. examples are extant, the American quilt as art and craft is largely a 19th-century phenomenon. Dozens of traditional patchwork patterns have evolved, such as Sunburst, Sawtooth, Log Cabin, Schoolhouse, and Bear's Paw, and have continued in use well into the 20th cent. The quilts of certain American groups are especially compelling works of art. Among the most notable of these were made by the Amish (particularly c.1870–1935) who created utilitarian quilts with geometric designs in areas of unpatterned color—deep, vibrant, and close-toned—now much sought after by collectors. The Victorian period marked the popularity of the crazy quilt, in which asymmetrical designs were made of patches of various textiles in a multiplicity of sizes and shapes often connected by decorative stitching.

Part of the American folk art tradition, quilting is still practiced by Southern mountainfolk, the Pennsylvania Dutch, and other rural dwellers and has been revived as ornamental needlework. Traditional African-American quilts have been particularly praised for their bold, asymmetrical designs and brilliant colors, often complemented by the use of tied knots. Of particular interest are quilts (1930s–present) created by the women of Gee's Bend, an historically black Alabama community—jazzy, colorful works in irregular geometric patterns of remarkable abstract power that have been widely exhibited, e.g., at the Whitney Museum of American Art, NYC (2002). The quilt has also been used as a form of textile art, as in the work of Faith Ringgold, who blends African-American tradition with contemporary art. Quilting also has a utilitarian function in modern life with machine-quilted materials used for wearing apparel and in interior decoration, particularly for bed and couch covers.