Fincastle was divided in 1776, with the western portion named Kentucky County, Virginia.

In 1780, Virginia set aside all land in Kentucky County for soldiers who had served in the Revolutionary War.

[5] The North and Middle Forks of the Kentucky River pass through the county as the main water drainages.

During the 20th century, Breathitt County was a Democratic stronghold typical of rural Appalachia, only voting Republican narrowly once.

Starting in 1912, Breathitt County continuously voted for the Democratic presidential nominee, a streak that would last until the 2004 election.

Since 2008, the county has voted for the Republican nominee each election by increasingly wide margins.

[12] In gubernatorial elections, Breathitt County has only voted for the Republican nominee on three occasions: 1907, 1919, and 2015.

The former includes a portion of Jackson and some unincorporated areas, while the latter has the remainder of the city and county.

Breathitt County health care providers were featured in a November 23, 2013, article in The Washington Post: "In Rural Kentucky, Health-Care Takes Back Seat as the Long-Uninsured Line Up".