An Italian immigrant to the U.S. in 1897 named Gennaro Lombardi opened a small grocery store in New York's Little Italy. An employee of his, Antonio Totonno Pero (also an Italian immigrant) began making pizza for the store to sell. Their pizza became so popular, Lombardi opened the first U.S. pizzeria in 1905 at 53 1/3 Spring Street, naming it simply Lombardi's. The price for an entire pizza was five cents, but since many people couldn't afford the cost of a whole pie, they could instead say how much they could pay and they were given a slice corresponding to the amount offered. It was closed in 1984 and then reopened in 1994 a block down, at 32 Spring Street. On November 10, 2005, Lombardi's celebrated its 100th anniversary by selling pizzas at the 1905 price, five cents, for the whole day.

In 1924, Totonno left Lombardi's to open his own pizzeria on Coney Island called Totonno's. Frank Pepe Pizzeria Napoletana opened in New Haven in 1925. Boston was introduced to pizza in 1926 by Anthony Polcari when he opened Pizzeria Regina in Boston's North End. The D'Amore family brought pizza to Los Angeles in 1939. At this point in time in the U.S., pizza consumption was still limited mostly to Italian immigrants.

The international breakthrough came after World War II. Allied troops occupying Italy, weary of their rations, were constantly on the lookout for good food. They discovered the pizzerias, and local bakers were hard pressed to satisfy the demand from the soldiers. The American troops involved in the Italian campaign took their appreciation for the dish back home, touted by "veterans ranging from the lowliest private to Dwight D. Eisenhower".

Due to the wide influence of Italian immigrants in American culture, the United States has developed quite a large number of regional forms of pizza, many bearing only a casual resemblance to the Italian original. During the latter half of the 20th century, pizza in the United States became an iconic dish of considerable popularity, and may have contributed to the decline of the British pie heritage previously common in American cuisine.

  • New York-style pizza is a style originally developed in New York City, where pizza is often sold in oversized, thin and flexible slices. It is traditionally hand-tossed and light on sauce, essentially amounting to a much larger version of the Neapolitan style. The slices are sometimes eaten folded in half, as its size and flexibility may otherwise make it unwieldy to eat by hand. This style of pizza tends to dominate the Northeastern states and is very similar to the basic style common through the United States and known simply as pizza. Many pizza establishments in the New York metropolitan area offer two varieties of pizza: "Neapolitan", or "round", made with a relatively thin, circular crust and served in wedge-shaped slices, and "Sicilian", or "square", made with a thicker, rectangular crust and served in large, rectangular slices.
  • Chicago-style pizza, or deep dish pizza contains a crust which is formed up the sides of a deep dish pan. It reverses the order of ingredients, using crust, cheese, filling, then sauce on top. Some versions (usually referred to as "stuffed") have two layers of crust with the sauce on top. Deep dish pizza was purportedly invented and first served in 1943 at Pizzeria Uno, which is still operating along with its twin restaurant, Pizzeria Due, in the River North neighborhood.
  • St. Louis-style pizza is a distinct style of pizza popular in St. Louis, Missouri and its surrounding areas. It is also sometimes duplicated in other areas of the Midwest. The most notable characteristic of St. Louis-style pizza is the distinctively St. Louisan provel cheese used instead of (or rarely in addition to) the mozzarella common to other styles of pizza. The pizza has a thin, round crust, as opposed to Chicago's deep-dish style or New York's pan-style. The crust of a St. Louis pizza is somewhat crisp and cannot be folded easily, and is typically cut into three- or four-inch squares instead of the pie-like wedges typical of other pizza. It is often salty and seasoned with more oregano than other pizza types. Despite its thin crust, it can be layered deeply with many different toppings. Sauces tend to have a sweetness to them, some more noticeably than others. The two largest St. Louis-style Pizza chains are Imo's Pizza and Cecil Whittaker's Pizzeria.
  • California-style pizza (often termed in the United States gourmet pizza) refers to pizzas with non-traditional ingredients, especially those that use a considerable amount of fresh produce.
  • Greek pizza is a variation popular in New England. It has a thicker, chewier crust and is baked in a pan in the pizza oven, instead of directly on the bricks. Plain olive oil is a common part of the topping.
  • Hawaiian pizza has Canadian bacon and pineapple toppings and is especially popular in the Western United States. Ham and pineapple is also a popular topping combination in Australia, but notably not in Hawaii. This type is also common within the EU as Pizza Hawaii.
  • Grilled pizza, invented in Providence, Rhode Island, uses a fairly thin crust cooked on a grill; the toppings are placed on the baked side after the pizza has cooked for a bit and flipped over.
  • English muffin or French bread pizza are common convenience pizzas made at home in an oven or toaster, usually with a simple topping of spaghetti sauce, sliced or shredded cheese, and perhaps pepperoni. French bread pizza is sometimes available commercially as a frozen meal.