Okonoko is located in northern Hampshire County, along the Potomac River and the CSX Cumberland Subdivision of the former Baltimore and Ohio Railroad.

Originally known as Cacaponville due to its proximity to the Little Cacapon River, the community's post office was established in 1843 and its name was changed to Okonoko in 1853.

[1][5] The community is centered along Okonoko Road (West Virginia Secondary Route 5/6), at the northern edge of forested mountain ridges, where Miller and Brights Hollows open into the Potomac River valley.

[5] According to an 1885 article in the South Branch Intelligencer, two of these mountain ridges were known locally as Mount Sinai and Levels Peak.

[17] During the American Civil War, Okonoko was the scene of an attempted raid on a Baltimore and Ohio Railroad train by Confederate raiders.

[29] On the night of April 10, 1864, shortly before the arrival of an east-bound express train, four privates of Company K, 54th Pennsylvania Infantry Regiment, were patrolling the road between Baltimore and Ohio Railroad stations.

[30] In February 1885, a young woman named Mary Cox, who resided near Okonoko and Little Cacapon, was administered two doses of morphine while ill, was mistakenly declared dead, and was subsequently buried alive.

[31][32][33] The following day, neighbors opened the grave to discover that Cox had been buried alive and had endured a frightful struggle to release herself from the casket, before dying.

[6] At that time, Okonoko consisted of residential dwellings located between the hillside to the south and the railroad's double tracks and a siding to the north, with the wagon road positioned within the remaining space along the Potomac River.

[44] In September of that year, L. P. Miller and Brothers orchard shipped an average of two train carloads of peaches daily from the Okonoko station.

[48] On October 21, 1958, the Western Union Telegraph Company applied to the Federal Communications Commission to close its railroad-operated agency office at the Okonoko railroad station, with services transferred to Cumberland, Maryland.