The phrase was not in use during Lovecraft's own lifetime; it was coined by Keith Herber for the Lovecraftian role-playing game Call of Cthulhu.

The term was coined by Keith Herber and then popularized by Chaosium, the producers of the Lovecraftian role-playing game Call of Cthulhu.

The story begins with a manifesto for why the New England countryside is a fitting backdrop for his horror stories: the true epicure of the terrible, to whom a new thrill of unutterable ghastliness is the chief end and justification of existence, esteem most of all the ancient, lonely farmhouses of backwoods New England; for there the dark elements of strength, solitude, grotesqueness, and ignorance combine to form the perfection of the hideous.

[7] In a 1930 letter to Robert E. Howard, Lovecraft attempted to explain his fascination with New England as a setting for weird fiction: "It is the night-black Massachusetts legendary which packs the really macabre 'kick'.

The location of Arkham was moved, as Lovecraft decided that it would have been destroyed by the Quabbin Reservoir, which was created to supply Boston with fresh water.

But he himself attempted to fill in the blanks of the setting, particularly in his posthumous "collaborations" with Lovecraft—actually Derleth's stories based on fragments, notes or ideas that Lovecraft left behind after his death.

The Lurker at the Threshold is set in Billington's Wood, a fictional forest north of Arkham, while "Witches' Hollow" takes place in the titular valley in the hills to the west of the town.

"Wentworth's Day" and "The Horror from the Middle Span" take place in the area north of Dunwich, while "The Gable Window" concerns a house on the Aylesbury Pike.

The Harvard Law Record used the phrase in an October 20, 2005, article: Many Lovecraft stories take place in "Lovecraft Country"—the fictional North Shore towns of Arkham, Innsmouth, Kingsport, and Dunwich (perhaps fictional equivalents of Ipswich, Salem/Danvers, Marblehead, or Newburyport).

[11]The most important portion stretches along the Miskatonic River valley, from Dunwich in its far western headwaters to its mouth entering the Atlantic Ocean between Arkham, Kingsport, and Martin's Beach."

The inhabitants are depicted as inbred, uneducated, and very superstitious, while the town itself is described as economically poor with many decrepit or abandoned buildings.

"[16] S. T. Joshi has also seen Dunwich as being influenced by East Haddam, Connecticut, location of the "Devil's Hopyard", the "Moodus Noises", and a witch tradition.

[17] Lovecraft places Dunwich in "north central Massachusetts", found by travellers "tak[ing] the wrong fork at the junction of the Aylesbury pike just beyond Dean's Corners."

[18] Dunwich is described as being surrounded by "great rings of rough-hewn stone columns on the hilltops", which are presumed to have been built by the Pocumtucks.

"[21] Lovecraft placed Innsmouth on the coast of Essex County, Massachusetts, south of Plum Island and north of Cape Ann.

Neil Gaiman's short story "Shoggoth's Old Peculiar" explains that the American Innsmouth was named after an older English village.

The town was "founded in 1643, noted for shipbuilding before the American Revolution, a seat of great marine prosperity in the early nineteenth century, and later a minor factory center."

Prior to the events of the story, in 1840, Marsh starts a cult in Innsmouth known as the Esoteric Order of Dagon, based on a religion he had learned from certain Polynesian islanders in his travels.

Then in 1846, a mysterious plague struck the town, killing most of the population, but in reality, the deaths were caused by the Deep Ones in league with Obed Marsh.

In 1929 he wrote with much feeling of seeing the snow-covered town at sunset and of experiencing his "first stupefying glance of MARBLEHEAD'S huddled and archaick roofs".

In the works of later writers, the town of Kingsport is described as having been founded in 1639 by colonists from southern England and the Channel Islands, where it soon became a seaport and center for shipbuilding.

And Cape Ann itself (the presumed site of Innsmouth) is connected to the mainland by only a thin strip of land and might be thought of as an island.