A surface water quality valuation index is developed and used to compare counties across the Appalachian Region. This index was based on a meta-analysis of non-market water quality valuation studies along with an application of benefit transfer. The results reveal that Pennsylvania, Georgia, and New York had the highest percentages of counties with high index values within the Appalachian Region. As this research was part of an inter-disciplinary team assembled by the Appalachian Regional Commission, results of this index can be compared to other indices computed for water resources in the region.