Objectives: A paucity of information exists to advise medical school applicants who have had to retake the Medical College Admission Test (MCAT) to achieve a competitive score. To better advise repeat test takers from West Virginia and other Appalachian and southern areas, MCAT data from West Virginia applicants were analyzed and compared with national data.Methods: In the application cycles of 2017-2020, the following factors were analyzed in relation to medical school acceptance in West Virginia applicants: MCAT scores, the number of test-taking attempts, biologychemistry-physics-math grade point average, time between test-taking attempts, and academic major. MCAT data from medical school applicants from West Virginia who took the test more than once also were compared with national data.Results: Of the total repeat test takers from West Virginia (N = 285) in the study timeframe, 57 (20%) were ultimately accepted into medical school. Factors associated with medical school acceptance were as follows: first MCAT test score (odds ratio [OR] 1.3, 95% confidence level [CL] 1.2-1.4, P < 0.001), change in MCAT test score (OR 1.2, 95% CL 1.1-1.3, P = 0.0015), and biology-chemistry-physics-math grade point average (OR 15.1, 95% CL 4.2-54.8, P < 0.0001). The highest benefit for improved scores occurred between the first and second attempts. The highest point gain occurred when the first MCAT score was in the range of 477 to 487 (<1st-12th percentile); this finding was not found in the national data.Conclusions: Although the study was limited to West Virginia medical school applicants, this information could prove useful in advising premedical applicants from other Appalachian and southern US areas.