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On February 23, 1977, Oscar Romero was appointed Archbishop of San Salvador. His appointment was met with surprise, dismay, and even incredulity. While this appointment was welcomed by the government, many priests were disappointed, especially those openly aligning with Marxism. The Marxist priests feared that his conservative reputation would negatively affect liberation theology's commitment to the poor.

On March 12, a progressive Jesuit priest and personal friend Rutilio Grande, who had been creating self-reliance groups among the poor campesinos, was assassinated. His death had a profound impact on Romero who later stated, "When I looked at Rutilio lying there dead I thought 'if they have killed him for doing what he did, then I too have to walk the same path". Romero urged Arturo Armando Molina's government to investigate, but they ignored his request. Furthermore, the censored press remained silent.

Tension was noted by the closure of schools and the lack of Catholic priests invited to participate in government. In response to Fr. Rutilio's murder, Romero revealed a radicalism that had not been evident earlier. He spoke out against poverty, social injustice, assassinations and torture. As a result, Romero began to be noticed internationally. In February 1980, he was given an honorary doctorate by the Catholic University of Leuven. On his visit to Europe to receive this honour, he met Pope John Paul II and expressed his concerns at what was happening in his country. Romero argued that it was problematic to support the Salvadoran government because it legitimized terror and assassinations.

In 1979, the Revolutionary Government Junta came to power amidst a wave of human rights abuses by paramilitary right-wing groups and the government. Romero criticized the United States for giving military aid to the new government and wrote to President Jimmy Carter in February 1980, warning that increased US military aid would "undoubtedly sharpen the injustice and the repression inflicted on the organized people, whose struggle has often been for their most basic human rights". Carter, concerned that El Salvador would become "another Nicaragua" and thus less business-friendly, ignored Romero's pleas and continued military aid to the Salvadoran government.

Romero was killed by a shot to the heart on March 24, 1980, while celebrating Mass at a small chapel located in a hospital called "La Divina Providencia", one day after a sermon where he had called on Salvadoran soldiers, as Christians, to obey God's higher order and to stop carrying out the government's repression and violations of basic human rights. According to an audio-recording of the Mass, he was shot while holding up the Eucharist. When he was shot, his blood spilled over the altar.