Before widespread school district consolidation, most American high schools were far smaller than their present-day counterparts. During the first decades of the 20th century, basketball quickly became the ideal interscholastic sport due to its modest equipment and personnel requirements. In the days before widespread television coverage of professional and college sports, the popularity of high school basketball was unrivaled in many parts of America. Perhaps the most legendary of high school teams was Indiana's Franklin Wonder Five, which took the nation by storm during the 1920s, dominating Indiana basketball and earning national recognition.

Today virtually every high school in the United States fields a basketball team in varsity competition.[14] Basketball's popularity remains high, both in rural areas where they carry the identification of the entire community, as well as at some larger schools known for their basketball teams where many players go on to participate at higher levels of competition after graduation. In the 2003–04 season, 1,002,797 boys and girls represented their schools in interscholastic basketball competition, according to the National Federation of State High School Associations. The states of Illinois, Indiana and Kentucky are particularly well known for their residents' devotion to high school basketball, commonly called Hoosier Hysteria in Indiana; the critically acclaimed film Hoosiers shows high school basketball's depth of meaning to these communities.

There is currently no national tournament to determine a national high school champion. The most serious effort was the National Interscholastic Basketball Tournament at the University of Chicago from 1917 to 1930. The event was organized by Amos Alonzo Stagg and sent invitations to state champion teams. The tournament started out as a mostly Midwest affair but grew. In 1929 it had 29 state champions. Faced with opposition from the National Federation of State High School Associations and North Central Association of Colleges and Schools that bore a threat of the schools losing their accreditation the last tournament was in 1930. The organizations said they were concerned that the tournament was being used to recruit professional players from the prep ranks.[15] The tournament did not invite minority schools or private/parochial schools.

The National Catholic Interscholastic Basketball Tournament ran from 1924 to 1941 at Loyola University.[16] The National Catholic Invitational Basketball Tournament from 1954 to 1978 played at a series of venues, including Catholic University, Georgetown and George Mason.[17] The National Interscholastic Basketball Tournament for Black High Schools was held from 1929 to 1942 at Hampton Institute.[18] The National Invitational Interscholastic Basketball Tournament was held from 1941 to 1967 starting out at Tuskegee Institute. Following a pause during World War II it resumed at Tennessee State College in Nashville. The basis for the champion dwindled after 1954 when Brown v. Board of Education began an integration of schools. The last tournaments were held at Alabama State College from 1964 to 1967.