The Amish did not bring the skill of quilt-making with them from Europe, but learned it from their non-Amish neighbours. The earliest known Amish-made quilts date from around the middle of the 19th century. The first ones were plain, with a different colour on each side, and geometrical motifs created by the quilting – the small running stitches which hold the three layers of the quilt together.

Later, quilters in Lancaster County started making pieced quilts with geometric forms. Typical of these quilts is the strongly centered motif surrounded by a wide border.

Traditional designs include bars and the center diamond. The bars are a pattern of straight vertical pieces surrounded by one or two borders. The center diamond is a large square standing on one of its corners, with a large triangles filling in each corner of the diamond so as to create a square within it. 

The quilters used wool fabrics in rich solid colors – printed and figured cloth was regarded as "worldly" and therefore to be avoided, though it is sometimes to be found on the reverse side.

Also typical of these quilts is the use of black fabric, which enhances the richness of the other colours.

Non-contrasting thread was used for the quilting itself, but the pattern of the stitching, particularly in the borders, could be highly complex.

Lancaster Amish quilts reflect Amish philosophy in their modesty, and in their use of geometric shapes: their religious convictions prevent them from using any kind of figurative representations.   

Other Amish communities living further west, for example in Ohio, Indiana and Iowa, were more open to outside influences and this can be seen in their quilts. This applies both to the motifs, where they are more open to the use of naturalistic designs, and to the fabric. Where almost all classic Lancaster quilts were made of wool, most of those produced in the Mid West were of cotton and later also of satin, or a mixture of fabrics.

The classic age of Amish quiltmaking in Lancaster County lasted from about 1870 to about 1940. It ended with the appearance of synthetic fabrics, which were less suited to the craft.

Amish quilts have been very influential in modern quilt design, and are now highly collectable and the old motifs are being copied for a new market.

In recent years, the Amish have started working with Hmong quilters, who came to the US from Vietnam at the end of the war and settled in Lancaster County.