The first State Highway Commission, established by Governor Charles B. Aycock in 1901, consisted of the state geologist, the commissioner of agriculture, and a third person selected to act as secretary. This early commission filed only one report (in 1902) during its one-biennium lifespan; it had no budget with which to operate and was expected to serve only in an advisory capacity. It was not until 1915 that another commission was formed during the waning months of Governor Locke Craig's administration, this one a seven-member panel that included the governor, the state geologist, two road engineers, and three citizens selected by the governor. The result of years of effort by state geologist Joseph Hyde Pratt to create such a body, this second commission was formed in large part to meet the requirements for receiving federal funds for highway construction. A third restructuring of the State Highway Commission occurred in 1919 with passage of the Stacey Bill, which enabled the newly appointed commission to direct the state's increasing involvement in road building. Fueled by a massive $50 million bond issued in 1921, the commission, headed by Frank Page, undertook the construction and maintenance of nearly 6,000 miles of highway.
The State Highway Commission is viewed as the predecessor to the North Carolina Department of Transportation. In 1941 the General Assembly created the Department of Motor Vehicles, consolidating services previously provided by the secretary of state and the Department of Revenue. The Department of Motor Vehicles, in turn, was combined with the State Highway Commission to form the North Carolina Department of Transportation and Highway Safety through the Executive Organization Act of 1971 (which also created the North Carolina Board of Transportation). In 1979 "Highway Safety" was dropped from the department's name when the Highway Patrol Division was transferred to the newly created Department of Crime Control and Public Safety.