Cho, a South Korean who had moved to the United States at age eight, was a senior English major at Virginia Tech. Cho had been diagnosed with and was treated for a severe anxiety disorder in middle school, and he continued receiving therapy and special education support until his junior year of high school. While in college in 2005, Cho had been accused of stalking two female students and was declared mentally ill by a Virginia special justice. At least one professor had asked him to seek counseling.

The incident received international media coverage and drew criticism of U.S. laws and culture from commentators around the world. It sparked intense debate about gun violence, gun laws, gaps in the U.S. system for treating mental health issues, the perpetrator's state of mind, the responsibility of college administrations, privacy laws, journalism ethics, and other issues. Television news organizations that aired portions of the killer's multimedia manifesto were criticized by victims' families, Virginia law enforcement officials, and the American Psychiatric Association.

The incident prompted immediate changes in Virginia law that had allowed Cho, an individual adjudicated as mentally unsound, to purchase handguns. It also led to passage of the first major federal gun control measure in more than 13 years, a law that strengthens the National Instant Criminal Background Check System, signed by President George W. Bush on January 5, 2008.

The Virginia Tech Review Panel, a state-appointed body assigned to review the incident, criticized Virginia Tech administrators for failing to take action that might have reduced the number of casualties. The panel's report also reviewed gun laws and pointed out gaps in mental health care as well as misinterpretations of privacy laws that left Cho's deteriorating condition in college untreated.