Virginia State Police said a car driving along US-23 Business near Appalachia Elementary School crossed the center line hitting an oncoming Jeep head on.
Appalachia Fire Department officials said the driver of the car was pinned beneath the vehicle when their crews arrived. The male driver was flown to Holston Valley Medical Center with serious injuries.
Three people in the Jeep were transported to Norton Community Hospital.
Charges are pending in the case.