North Carolina's 5th congressional district covers the central western portion of North Carolina from the Appalachian Mountains to the western suburbs of the Piedmont Triad. The district borders Tennessee and Virginia, with the bulk of its territory in the mountains; it stretches just far enough to the east to grab its share of Forsyth County, home to most of its population.

Forsyth County is located in the northwest Piedmont of the U.S. state of North Carolina. As of the 2020 census, the population was 382,590, making it the fourth-most populous county in North Carolina. Its county seat is Winston-Salem. Forsyth County is part of the Winston-Salem, NC, Metropolitan Statistical Area, which is also included in the Greensboro–Winston-Salem–High Point, NC, Combined Statistical Area. Portions of Forsyth County are in the Yadkin Valley wine region.