[1] Andy Partridge, of fellow Virgin act XTC, and John Leckie were hired to produce, and recording sessions at Rockfield Studios[2] in Monmouth, Wales took place in November 1984.

[3] However, Partridge and Leckie, having found themselves at odds with O'Hara and her backing band over the course of recording, were ultimately fired from the project;[3] in their place, Joe Boyd was hired by Virgin to oversee the sessions.

[6] In Now, Kim Hughes noted the album's minimalist production and varied musical styles, comparing its "acoustic guitar sound and liberal use of lap steel" to the country genre, while also finding that the "slinky bass lines and cool piano" of certain tracks "evoke a smokey jazz feel".

[7] According to Hughes, the songs on Miss America are characterized by O'Hara's "inimitably high-pitched, breathy and erratic ... high and low, brittle and soothing" vocals, as well as "her ethereal, often ambiguous lyrics".

[8] Nonetheless, positive press coverage of the album encouraged the label to issue "Body's in Trouble" as a single in February 1989, with an accompanying music video for the song also being produced.

[1][8] The Globe and Mail's Chris Dafoe stated that "O'Hara's vocals are all over the place, by turns incantatory, melancholy, slinky and delicate, while the music flirts with country, jazz and pop without ever committing seriously to any one style.

"[13] In a retrospective review for AllMusic, Jason Ankeny stated that "Miss America still sounds light years ahead of its time: Mary Margaret O'Hara is a force of nature, a remarkable singer and composer whose crystal-clear soprano acrobatics and hypnotic songs defy accepted conventions.

"[12] Writing for Pitchfork in 2018, Laura Snapes opined that it ranks alongside "David Lynch's Blue Velvet, Tom Waits' Swordfishtrombones, and Leonard Cohen's I'm Your Man" as one of the 1980s' "jarring noir masterpieces".

Morrissey, on whose 1990 songs "November Spawned a Monster" and "He Knows I'd Love to See Him" O'Hara provided additional vocals, said of the album: "I thought it so beautiful I suddenly realised I hadn't in a decade heard someone singing because of deep-set personal neurosis, absolute need and desperation.

[28] Other artists who have covered songs from Miss America include This Mortal Coil ("Help Me Lift You Up"),[29] the Walkabouts ("Dear Darling"),[30] the Art of Time Ensemble and Sarah Slean ("To Cry About"),[31] Devon Sproule and Perfume Genius (both of whom recorded versions of "Body's in Trouble"),[32][33] and Bria Salmena ("When You Know Why You're Happy").