Alexandria Mills, a soft-spoken 18-year-old, was named the winner in Saturday night's contest in southern China. The tall blonde was a relative surprise winner after speculation focused on other contestants.
Second place went to Emma Wareus of Botswana, and Adriana Vasini of Venezuela came third.
The host country's own contestant, Tang Xiao, also was among the final five.
According to a brief biography on the Miss World website, Mills calls Louisville, Kentucky, her hometown, and she recently graduated from high school. She would like to become a teacher.
"I've never met a stranger and enjoy meeting new people," she says in the bio.
For the final, she was wearing a shimmering ivory-colored dress slit up the leg.
Mills takes over the title from Kaiane Aldorino of Gibraltar, who was named Miss World 2009 at a ceremony in South Africa last December.
Women from more than 100 countries participated in the contest, organizers said.
This is the 60th year of the Miss World Competition, and organizers brought back contestants from past decades to give the night a retrospective theme.
Miss USA Alexandria Mills, 18, is crowned as she wins the Miss World 2010 title in Sanya, on the Chinese island of Hainan October 30, 2010.
MISS WORLD 2010: UNITED STATES, Alexandria Mills
1st Runner-up: Botswana, Emma Wareus
2nd Runner-up: Venezuela, Adriana Vasini
3rd Runner-up: Ireland, Emma Britt
4th Runner-up: China, Xang Tiao
5th Runner-up: Norway, Mariann Birkedal
6th Runner-up: Italy, Giada Pezzaioli
Top 25 Semi Finalists:
Bahamas (Braneka Bassett), Canada (Denise Garrido), Colombia (Laura Palacio), France (Virginie Dechenaud), French Polynesia (Mihilani Teixeira), Germany (Susanna Kobylinski), Kenya (Natasha Metto), Mongolia (Sarnai Amar), Namibia (Odile Gertze), Paraguay (Egny Eckert), Puerto Rico (Yara Lasanta), Russia (Irina Shapirova), Scotland (Nicola Mimnagh), South Africa (Nicole Flint), St. Lucia (Aiasha Gustave), Thailand (Sirirat Rueangsri)
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Continental Queens of Beauty
Queen of Americas: United States
Queen of Europe: Ireland
Queen of Africa: Botswana
Queen of Asia & Oceania: China
Queen of Caribbean: Puerto Rico
Tidbits: Miss Norway (Mariann Birkedal) competed in the Miss Universe 2008 contest in Vietnam, where she was unplaced. Misses Netherlands (Desiree van den Berg), Bahamas (Braneka Bassett)