Hillsville is located in central Carroll County at (36.758814, −80.734510). U.S. Routes 52 and 221 intersect in the center of town, while U.S. Route 58 bypasses the town to the south. US 52 leads northwest to Wytheville and south to Mount Airy, North Carolina, while US 221 leads northeast to Roanoke and southwest to Galax. US 58 leads east to Martinsville and west to Galax with US 221. The Hillsville town limits extend west along US 221 and 58 to Interstate 77, which leads north to Interstate 81 east of Wytheville and south to Interstate 74 in North Carolina.