The 6.2 magnitude earthquake that hit the region Wednesday was shallow, about 6 miles underground, which caused more damage than a deeper quake.
The mayor of Amatrice — one of the towns affected — said "half the town no longer exists."
"It felt like the bed was on rollers, and we all kind of ran out," a witness told CNN.
Earthquakes in the area aren't historically uncommon. The last major one was in 2009.
Italy sits on two fault lines, making it more susceptible to earthquakes than many other European countries.