Hillsbrad Foothills was radically changed in Cataclysm. A former grassy zone with World PvP between the Alliance town of Southshore and the Horde town of Tarren Mill, the Forsaken have taken over the zone after the Shattering. Southshore is destroyed due to plague experiments, and toxic waste covers much of the zone. This zone has also been merged with Alterac Mountains, a snowy plateau populated by ogres and surrounded by the Syndicate.

Southshore is viewed by many Horde players to be one of the best questing zones, due to both sentimental plotlines and a series of quests that turns your character into a questgiver ordering NPCs around.

In Alterac Mountains, players can queue for Alterac Valley and pick up associated quests.