Construction of the Gregg County Airport and terminal was completed and the airport opened on 15 July 1947. Once open, Mid-Continent and Delta Air Lines serviced the airport with commercial flights. Many improvements happened over the years, including runway lights, approach lights, and an instrument landing system. Big changes came in 1970, when the 10,000 ft (3,000 m) paved runway 13/31 was completed, and in 1976 when a new air traffic control tower was built. In 2002, the airport was renamed the East Texas Regional Airport. In 2007 the airport was awarded a $6.5 million Airport Improvement Program grant to accomplish major updates to the facility. Included among the projects were the resurfacing of Runway 13/31, as well as the relocation of the ILS glideslope and MALSR due to the creation of an 800' displaced threshold on Runway 13 to comply with FAA runway safety area standards. Former taxiway H (at the intersection of 18/36 and 13/31) was demolished after being identified as a potential hot spot for runway incursions. The improvements were completed in 2009.

On 8 October 1992, the airport was the first of two stops for Ferry Flight 58 of Space Shuttle Atlantis between the Kennedy Space Center and Palmdale, California, where Atlantis was sent for orbiter maintenance.