The United States 'warming hole' is a region in the southeast/central U.S. where observed long-term surface temperature trends are insignificant or negative. We investigate the roles of anthropogenic forcing and internal variability on these trends by systematically examining observed seasonal temperature trends over all time periods of at least 10 years during 1901-2015. Long-term summer cooling in the north central U.S. beginning in the 1930s reflects the recovery from the anomalously warm 'Dust Bowl' of that decade. In the northeast and southern U.S., significant summertime cooling occurs from the early 1950s to the mid 1970s, which we partially attribute to increasing anthropogenic aerosol emissions (median fraction of the observed temperature trends explained is 0.69 and 0.17, respectively). In winter, the northeast and southern U.S. cool significantly from the early 1950s to the early 1990s, but we do not find evidence for a significant aerosol influence. Instead, long-term phase changes in the North Atlantic Oscillation contribute significantly to this cooling in both regions, while the Pacific Decadal Oscillation also contributes significantly to southern U.S. cooling. Rather than stemming from a single cause, the U.S. warming hole reflects both anthropogenic aerosol forcing and internal climate variability, but the dominant drivers vary by season, region, and time period.