Its name is due to its proximity to the highest point of the city, which is a few blocks south, at the intersection of Arsenal Street and Sublette Avenue, around 38°36'22.12" North, 90°16'53.1" West (38.6061440, -90.2814178). The intersection borders Sublette Park, the former site of the "Social Evil Hospital"  built there in 1873.
With the growth of Italian immigrants came the growth in the influence of the Roman Catholic Church. By the time a new structure was built for what became known as St. Ambrose in 1926, the church had already been a force in the area for over twenty years. The structure  is modeled after San Ambrogio Church in Milan, in an Lombard-Romanesque style of brick and terra cotta. It became the parish church for the area in 1955, after thirty years of focusing on those of Italian heritage.
That heritage remains evident today. As of May 2003, about three-quarters of the residents are Italian-Americans, helped perhaps by the practice of rarely listing homes on the open market . The neighborhood is home to a number of locally renown Italian restaurants, bakeries, grocery stores, and bocce gardens.
Baseball greats Yogi Berra and Joe Garagiola grew up on the Hill; their boyhood homes are across the street from each other on Elizabeth Avenue. Four of the five St. Louisans on the US soccer team that defeated England in the 1950 World Cup tournament came from here, a story that is told in The Game of Their Lives, a book (ISBN 0805038752) and (unreleased as of 2003) documentary.