The 14th Five-Year Plan of China proposes promoting urbanization construction, with counties as an important carrier. In order to evaluate the urbanization development level of counties in Western China, this study established an index system of population, land, and industry, constructed the coupling coordination model, selected Shaanxi Province as a representative case, and evaluated the comprehensive development level and its coordination degree of urbanization at the county level. The results show that: (1) there are two stages of urbanization in Western counties, namely "increment" and "quality improvement"; (2) county urbanization in Western China radiates from central cities, presenting the characteristics of a "core-edge" circle structure. Northern Shaanxi has significant spatial difference characteristics, the coordination and development level of the Guanzhong area are both in the lead, and Southern Shaanxi is still in the stage of weak level coordination; (3) unlike urbanization in metropolises, urbanization in Western counties is mainly driven by industrial agglomeration instead of land urbanization. However, population outflow is an obstacle to the urbanization of Western counties. The evaluation of the coordinated development of county urbanization can provide a theoretical basis and practical path for enhancing public service functions in counties, guiding urban–rural harmonious development.