[5] Creston was originally settled in 1868 as a survey camp for the Burlington and Missouri Railroad.

It was named for the fact that it was on the crest of the railroad line between the Missouri and Mississippi river basins.

Creston was chosen as the division point for the railroad, who built machine shops, a roundhouse, and a construction camp in the new town.

Railroad employees, including African Americans, were recruited from Chicago and other major cities to work in Creston.

The Chicago, Burlington and Quincy Railroad (CB&Q) opened a new station in Creston in 1899.

The three-story, yellow brick Creston station is in the French Provincial style, with a red-tiled mansard roof.

[6] Creston's economy and population were affected during the mid-20th century by a reduction in passenger train service and decline in railroad employment.

The old machine shop building was destroyed by a tornado in 1946 and the remainder of the roundhouse burned down in 1981.

The railroad, now BNSF Railway, continues to be a major hauler of grain and coal in the region and uses Creston as a crew change point: Creston-based crews operate trains between Creston and Lincoln, Nebraska, while crews from Galesburg, Illinois and Lincoln stay in Creston before returning home.

Creston is served by Amtrak's daily Chicago–San Francisco Bay Area California Zephyr.

The tornado caused considerable damage to the hospital, community college, Kingdom Hall of Jehovah's Witnesses, and the high school.

The college suffered roof and window damage to its dorms and students were transferred to local hotels for the rest of the school semester.

[9] The Greater Regional Medical Center was two weeks from an open house to unveil a major renovation when it was severely damaged by the tornado.