Maynard Field, a predecessor of PTI Airport and one of the first commercial airports in the South, was dedicated on December 6, 1919, just west of Greensboro near Oak Ridge. With its two intersecting runways measuring 1,890 feet (580 m) and 1,249 feet (381 m), hangar space, and even an early day equivalent of a Fixed-Base Operator that made sure the torches were lit at dusk, Maynard Field was named to honor a young North Carolinian pilot named Lt. Belvin Maynard. By 1922 it had competition to the west with Miller Field in Winston-Salem, and Charles Field, a single airstrip that was used mainly for barnstorming, and for take-off drills and landings for the Charles family.

Piedmont Triad International Airport had its start in 1927 when the Tri-City Airport Commission selected 112 acres (45 ha) near the community of Friendship for an airport, and petitioned to become a stop along the congressionally authorized airmail route from New York to New Orleans. Racing pilot Captain Roscoe Turner referred to the current location of Piedmont Triad International Airport as "the best landing field in the south". Friendship, near Greensboro, was selected over neighboring Winston-Salem, which subsequently refused to contribute funds for airport construction and nullified the Tri-City Airport Authority collaborative effort.

Greensboro and Guilford County jointly purchased the Friendship property from Paul C. and Helen G. Lindley, and named it Lindley Field in May 1927 with 12,000 people in attendance. The field then had no runways, no lights, no hangar, and no passenger station. Charles Lindbergh stopped at Lindley Field with the Spirit of St. Louis on his cross-country tour celebrating the advances of aviation on October 14, 1927. Regular mail service started in 1928.

Pitcairn Aviation, Incorporated, was given the contract to fly the airmail route, the second official airmail route in the United States, and made the first delivery of airmail in North Carolina on May 1, 1928. Sid Malloy, the pilot of the aircraft, landed with two bags of mail and took three bags of mail to be sent to Atlanta. After a brief closure during the Great Depression, the airport reopened on May 17, 1937, with two all-weather runways. In time, Pitcairn Aviation built a hangar; Greensboro built a passenger station; the United States government established a weather bureau; and the Department of Commerce set up a radio tower. Passenger service was inaugurated by Dixie Flying Service on November 6, 1930, with a route to Washington, D.C. Pitcairn Aviation took over the route under its new name Eastern Air Transport, which later became Eastern Air Lines.

In July 1942, responsibility for the airport was given to the Greensboro-High Point Airport Authority, with representatives from Greensboro, High Point, and Guilford County. Shortly thereafter the Army Air Corps requisitioned the airport and its facilities for war use and airmail and passenger service was discontinued. The corps lengthened the runways and built a new passenger terminal. Civilian service resumed after the war, though growth was moderate due to the success of nearby Smith Reynolds Airport in Winston-Salem.

A new passenger terminal opened in 1958, replacing the temporary facility that had served since World War II. The terminal was a modern glass paneled structure with a single pier. PTI was then served by Eastern, Piedmont, and Capital (which merged with United in 1961). The April 1957 Official Airline Guide showed departures each weekday by Eastern (17), Piedmont (9), and Capital (7).

During the 1970s the airport was renamed Greensboro–High Point Airport and then later Greensboro–High Point–Winston-Salem Regional Airport. Work on a new facility began in 1978 and the airport gained a greater prominence on the East Coast, offering passenger service from Delta Air Lines, Piedmont Airlines, United Airlines and Eastern Air Lines. Cargo carriers, including the postal service, textile manufacturers, and Federal Express–a new overnight letter and package delivery service–were shipping tons of freight each year. By 1975, airport officials began to plan for a new terminal. Piedmont Airlines announced its intention to consolidate its operations at Greensboro, but in the months that followed, opened a hub in Charlotte instead.

The new terminal complex was completed in 1982, designed by Reynolds, Smith & Hills and AHM Architects. The following year, the Marriott opened a $16 million, 300-room hotel on the airport property. The facility was renamed Piedmont Triad International Airport in 1987.

TIMCO Aviation Services (purchased by HAECO Americas in 2014, which was in turn acquired by AAR Corp. in 2025) opened its world headquarters at PTI in 1990, and grew into one of the world's largest independent aircraft maintenance, repair and overhaul providers. In 1993, Continental Lite, established a hub at PTI, but by 1995 the hub lost its parent company, Continental Airlines $140 million and Continental ceased hub operations at PTI. In 1998 FedEx Corporation announced its intentions to build a mid-Atlantic hub at PTI, one of only five FedEx hubs in the country.