And in November, Virginia voters approved commercial casino development in four cities (Bristol, Danville, Norfolk and Portsmouth), while Richmond and Petersburg are potential sites for the state's fifth casino location. The Fifth District is home to 11 operating commercial casinos (six in Maryland and five in West Virginia) and three tribal casinos (in North Carolina), which collectively employed roughly 38,000 people as of the end of 2021, according to the American Gaming Association. Such debate has occurred in the Fifth Federal Reserve District, where casinos are playing a potentially increasing role. This has generated much debate about their role in regional economic development. As of June 2022, they were legal in over 30 states and coexist with over 500 tribal casinos nationwide.

Until the late 1980s, commercial casinos were legal in only two states: Nevada and New Jersey. Casinos are more common across the country now than they were a generation ago.