Prior to the arrival of the European colonists, Tangier Island was a summer retreat for the Pocomoke Indians for centuries. Although not much is known about these people, their existence is evidenced by the thousands of stone arrowheads that have been found all over the island. Almost any morning after gale force winds have been blowing all night, new arrowheads can be found on the beach, uncovered by the blowing away of sand. The discovery of an ancient oyster midden offshore, thousands of years old, consisting of a huge pile of shells which could only have been deposited by humans, is further evidence that there was a regular population on Tangier, at least in the warm part of the year, long before it had an English name. The enormous amounts of arrowheads and spear points found here suggest the island probably was much larger than recorded history can verify, and home to many animal species.
The first known European explorer of the island was John Smith. He named Tangier and the surrounding islands the "Russel Isles" after the doctor on board his ship.
In 1670, Ambrose White received a patent for 400 acres (160 ha) called "an Island in the Chesapeake Bay". The next year White assigned his patent to Charles and John West. In 1673 William Walton was granted 400 acres on the western island which was formerly patented by White. There is a similar entry in the patent book three years later, but Scarburgh and West were the recipients instead of Walton, and in 1678 a formal patent was issued to both of them. Charles Scarburgh (often now spelled Scarborough) left his interest to his wife Elizabeth in 1702, and John West's interest went to his eldest son a year later. In 1713, two patents were granted to Elizabeth Scarburgh and Anthony West for Tangier Islands. One was for 900 acres (360 ha), which included the original 400 acres (160 ha) plus 500 acres (200 ha) more found within its bounds. The other grant was for 170 acres (69 ha) of new land south of Tangier called "Sandy Beach Island" which was probably the hook-shaped part that is now attached to the main of the island. This was the first time Tangier Islands was named in the records. Although Elizabeth Scarburgh left her interest to her daughters, the title went to her oldest son, Bennett. It then passed to Henry Scarburgh and then to a Charles Scarburgh. In 1762, Charles Scarburgh confirmed an undeeded sale of his half to Colonel Thomas Hall. The next year Hall sold this to William Andrews as 475 acres (192 ha).
Today many of the inhabitants still have the surname Crockett. Pruitt, Thomas, Marshall, Charnock, Dise, Shores, and Parks are other common surnames on the island.