Massachusetts is divided into four topographical regions: coastal lowlands, interior lowlands, dissected uplands, and residuals of ancient mountains. The coastal lowlands, located on the state's eastern edge, extend from the Atlantic Ocean 30–50 mi (48–80 km) inland and include Cape Cod and the offshore islands. The northern shoreline of the state is characterized by rugged high slopes, but at the southern end, along Cape Cod, the ground is flatter and covered with grassy heaths.

The Connecticut River Valley, characterized by red sandstone, curved ridges, meadows, and good soil, is the main feature of west-central Massachusetts. The Berkshire Valley to the west is filled with streams in its northern end, including the two streams that join below Pittsfield to form the Housatonic River.

East of the Connecticut River Valley are the eastern uplands, an extension of the White Mountains of New Hampshire. From elevations of 1,100 ft (335 m) in midstate, this ridge of heavily forested hills slopes down gradually toward the rocky northern coast.

In western Massachusetts, the Taconic Range and Berkshire Hills (which extend southward from the Green Mountains of Vermont) are characterized by numerous hills and valleys. Mt. Greylock, close to the New York border, is the highest point in the state, at 3,487 ft (1,064 m). Northeast of the Berkshires is the Hoosac Range, an area of plateau land. Its high point is Spruce Hill, at 1,974 ft (602 m).

There are more than 4,230 mi (6,808 km) of rivers in the state. The Connecticut River, the longest, runs southward through west-central Massachusetts; the Deerfield, Westfield, Chicopee, and Millers rivers flow into it. Other rivers of note include the Charles and the Mystic, which flow into Boston harbor; the Taunton, which empties into Mount Hope Bay at Fall River; the Blackstone, passing through Worcester on its way to Rhode Island; the Housatonic, winding through the Berkshires; and the Merrimack, flowing from New Hampshire to the Atlantic Ocean via the state's northeast corner. Over 1,100 lakes dot the state; the largest, the artificial Quabbin Reservoir in central Massachusetts, covers 24,704 acres (9,997 ha). The largest natural lake is Assawompset Pond in southern Massachusetts, occupying 2,656 acres (1,075 ha).

Hilly Martha's Vineyard is roughly triangular in shape, as is Nantucket Island to the east. The Elizabeth Islands are characterized by broad, grassy plains.

Millions of years ago, three mountainous masses of granite rock extended northeastward across the state. The creation of the Appalachian Mountains transformed limestone into marble, mud, and gravel into slate and schist, and sandstone into quartzite. The new surfaces were worn down several times. Then, during the last Ice Age, retreating glaciers left behind the shape of Cape Cod as well as a layer of soil, rock, and boulders.