Crewe was founded in 1888 as a central location to house steam locomotive repair shops for the Norfolk & Western Railroad (now called Norfolk Southern) which has a rail yard there for east-west trains carrying Appalachian coal to Hampton Roads for export abroad, and the street pattern was laid out at that time. It was named for the large railroad town of Crewe, England.

The railroad repair facility's importance diminished sharply in the 1950s, as the switch to diesel-electric locomotives required less labor and equipment. Crewe has a small railroad museum. Lottie Moon, a noted Baptist missionary to China, is buried in the town cemetery. A chicken festival is held annually on the third Wednesday in June, as well as the town Homecoming Celebration on the third weekend in May.

The Battle of Sayler's Creek, the last major American Civil War engagement before the Army of Northern Virginia's surrender at Appomattox Court House, occurred nearby. The Southside Electric Cooperative and the Piedmont Geriatric Hospital are in the vicinity as well.

Millbrook and Mountain Hall are listed on the National Register of Historic Places. Screenwriter and short story writer Robert Buckner was born in the town.

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