Chief Engraver Gasparro was tasked with creating a design for the proposed coin. His obverse design depicted a bust of Liberty, while his reverse depicted a soaring eagle. The bust was pictured along with a pole, atop which sat a Phrygian cap, a symbol used to represent freedom. Gasparro's Liberty design was based on a similar obverse that he created for a 1969 American Numismatic Association convention medal. The reverse, depicting an eagle flying above a mountain against the rising Sun, was originally created by Gasparro in 1967 for a proposed commemorative half dollar. Describing the reverse design, Gasparro stated that it was meant to symbolize "a new day being born".

The design was reviewed by the Commission of Fine Arts, and in an April 29, 1976, letter, Commission member J. Carter Brown praised the design:

I believe this would be a superb design for United States Coinage, rooted as it is in a great tradition, being based on the 'Liberty Cap cent' of 1794, following Augustin Dupré's Libertas Americana medal commemorating Saratoga and Yorktown (1777–1781).

A bill to reduce the diameter of the dollar from 1.5 inches (38 mm) to 1.043 inches (26.5 mm) and the weight from 22.68 grams to 8.5 grams was introduced to the House of Representatives on May 1, 1978. The bill was introduced to the Senate on May 3, and the proposed weight was reduced from 8.5 grams to 8.1 grams. The Mint conducted experiments involving eight-, ten-, eleven- and thirteen-sided coins, but it was decided that the dollar would be round, as costly modifications would be required to update vending machinery to accept other shapes. Instead, the bill prescribed an eleven-sided inner border, which was intended to aid identification by sight and by feel for the visually handicapped.

Treasury officials officially recommended Gasparro's design, which they referred to as a "modernized version of the classic Liberty design". On May 3, 1978, Wisconsin's William Proxmire introduced legislation in the Senate which was identical to the Treasury proposal, except for mandating a design which was altered to social reformer Susan B. Anthony in place of the allegorical Liberty. On May 15, Representatives Mary Rose Oakar and Patricia Schroeder introduced similar legislation to the House of Representatives. Anthony was also recommended by members of the National Organization for Women, the Congresswomen's Caucus, the National Women's Political Caucus and the League of Women Voters. In support of the proposed legislation, the League addressed a letter to Walter E. Fauntroy, chairman of the Subcommittee on Historic Preservation and Coinage, reading in part:

The League believes that the time has come, and is indeed long past, for the likeness of a prominent American woman to be placed on a denomination of U.S. currency. We believe strongly that the likeness should be that of an actual woman and not that of an imaginary or symbolic figure. Susan B. Anthony contributed immeasurably to the advancement of human dignity in this nation. It is entirely fitting and appropriate that her memory be honored through this measure.

In addition, officials tallied suggestions sent to the Mint by the general public as to the subject of the dollar coin, and Susan B. Anthony had received the most support.

Gasparro began work on his Susan B. Anthony design in June 1978, before the legislation was authorized by Congress. He enlisted the help of a friend in conducting research on Anthony, which he felt was necessary before creating the design. He referenced approximately six different images while creating the portrait of Anthony, but it was based largely on just two. Gasparro created several different designs before receiving final approval. One of his portraits, depicting Anthony at age 28, was shown to Anthony's great-niece, Susan B. Anthony III, who rejected it on the grounds that it unnecessarily "prettified" her great-aunt, and she criticized another design depicting Anthony at age 84, which she believed made her appear too old. Gasparro made several alterations with the intent to depict her at age 50, at the peak of her influence as a social reformer, but no photographs of Anthony during that period are known to exist. He eventually received approval after modification, later stating his belief that he had accurately portrayed Anthony.

Initially, Gasparro expected that Congress would retain his soaring eagle reverse design to accompany the Susan B. Anthony obverse. However, a late amendment introduced by Utah Senator Jake Garn altered the legislation to maintain the Apollo 11 design in use on the Eisenhower dollar reverse.

The bill was approved by Congress and signed into law by President Jimmy Carter on October 10, 1978, and production of Eisenhower dollars ceased during that year. After he signed the bill into law, Carter issued a statement, saying in part that he was confident that "this act—and the new dollar—will substantially improve our coinage system as well as cutting Government coin production costs". He went on to declare his approval of the decision to depict Anthony on the coins:

I am particularly pleased that the new dollar coin will—for the first time in history—bear the image of a great American woman. The life of Susan B. Anthony exemplifies the ideals for which our country stands. The 'Anthony dollar' will symbolize for all American women the achievement of their unalienable right to vote. It will be a constant reminder of the continuing struggle for the equality of all Americans.

Gasparro regarded the Anthony design as the most important of his career. Remarking on the public perception of the coin, Gasparro related that "it's become part of a social movement. This new dollar's more than a coin; it's an issue." The decision to use a portrait of Susan B. Anthony in place of the allegorical Liberty was met with criticism by most numismatists, who believed that the Liberty design had far greater artistic merit. Art critic and numismatist Cornelius Vermeule was highly critical of the obverse design replacement, as well as the decision to continue use of the Apollo 11 design. Vermeule noted that although Eisenhower's administration established the National Aeronautics and Space Administration, Anthony had no connection to the Moon landing or the U.S. space program. Commenting on the obverse and reverse pairing, he stated his belief that it was "a hasty marriage and a bad one". Although he believed that Gasparro's Anthony design was well executed, sculptor Robert Weinman criticized the decision to depict Anthony. Concerned about the possibility of other groups seeking representation on the coinage in response to its passage, Weinman characterized the Susan B. Anthony dollar legislation as a "billboard or campaign button approach to a national coin".

The first Susan B. Anthony dollars were struck at the Philadelphia Mint on December 13, 1978. First strikes at the Denver and San Francisco Mints followed on January 9, 1979 and January 29, respectively. Mint officials feared that the coins would be hoarded upon release, so they ordered the creation of a stockpile consisting of 500 million coins prior to the release date on July 2, 1979. The dollars all bore a mint mark denoting their place of origin: 'P' for the Philadelphia Mint, 'D' for the Denver Mint and 'S' for the San Francisco Mint. The Anthony dollar was the first coin to bear a 'P' mint mark since the Jefferson nickel issued during World War II; other coins struck there were left without a mint mark to note their place of origin. In 1980, the 'P' mint mark was added to all other circulating coins, except the cent, struck in Philadelphia.

The Treasury Department, in cooperation with the Federal Reserve, undertook a $655,000 marketing campaign to educate bank employees and members of the public about the new coin, and the vending industry engaged in a $100 million effort to retrofit machines to accept the coins.

Despite the marketing attempts, the coin received an overwhelmingly negative reception from the public. In 1979, 66% of the national population disliked the coin. Less than two millimeters in diameter larger than the quarter and struck in the same copper-nickel composition, the Susan B. Anthony dollar was widely confused for that denomination in transactions. Mint Director Hackel noted the difference in weight and design between the two coins and expressed her belief that the dollar would eventually find favor with the public, suggesting that the coin would become "customary to the American people in time". In the months following its release, complaints mounted and public transportation and many establishments throughout the country began refusing to accept them in payment. On July 13, 1979, California Representative Jerry Lewis introduced a bill to the House of Representatives with the intent to increase the size of the coin to aid identification. Discussing the bill, which was never passed, Lewis remarked that the Anthony dollar had come to be known derisively as the "Carter quarter", due to its size and association with the President.

In total, 757,813,744 dollar coins dated 1979 were struck for circulation at the Philadelphia, Denver and San Francisco Mints. Demand remained low through 1980, and the circulation strikes for that year totaled 89,660,708. Due to its persistent unpopularity, production of Anthony dollars for circulation was suspended, and 9,742,000 1981 dollars were struck across all three Mints exclusively for sale to collectors; this mintage marked the end of production. At the close of production, the Treasury encountered a dilemma: the Mint struck a large number of dollars in anticipation of great public demand, resulting in a surplus of 520,000,000 coins in 1981. Melting the coins was impractical; the cost of manufacture was approximately 2 cents, and the 98 cents earned from seignorage was applied to the national debt. Had the coins been melted, their seignorage would have been added to the debt. Accordingly, the coins were placed in government storage, to be dispensed as needed.

The coin's design did have repercussions north of the border; when Canada introduced its new one-dollar coin in 1987, its dimensions were made similar so that vending machine specifications could be common between the two nations.

When the Baltimore Metro opened in 1984, it used the Susan B. Anthony dollar coin as tokens with which to buy tickets. It became the largest single user of Susan B. Anthony dollar coins in its history.

Despite their unpopularity in transactions, Anthony dollars began to see heavy use in over 9,000 stamp-dispensing machines situated in United States Postal Service buildings across the country beginning in the early 1990s. Additionally, the coins finally began to be used regularly with many mass-transit systems and vending-machine operations. Various propositions were discussed in Congress since the last dollars were produced in 1981, but no action was taken to issue a new coin until the Treasury's stores of Anthony dollars became depleted by the mid-1990s. In February 1996, the vaults totaled approximately 229,500,000 coins, but that number was reduced to approximately 133,000,000 by the end of 1997. Faced with the necessity of striking more Susan B. Anthony dollars to fill the demand, the Treasury supported legislation authorizing a new dollar coin that would not be confused with the quarter. Legislation authorizing a dollar coin in a gold-colored composition and with a plain edge was introduced to the House and Senate in 1997, where it eventually received approval with a provision calling for it to depict Native American guide Sacagawea. On December 1, 1997, President Bill Clinton signed the 50 States Commemorative Coin Program Act into law. The Act, which authorized the creation of the 50 State Quarters program, included a section entitled "United States $1 Coin Act of 1997". That section officially authorized what became the Sacagawea dollar.

Following passage of the act, a series of test strikes depicting Martha Washington were carried out to test various gold-colored alloys. Although the act provided for creation of the new coin, it also allowed for resumption of striking the Anthony design as a stop-gap measure until production began on the gold-colored dollar. Nearing depletion of Treasury stockpiles, on May 20, 1999, the U.S. Mint announced that production of the Susan B. Anthony dollar would resume. In total, 41,368,000 Anthony dollars dated 1999 were struck for circulation at the Philadelphia and Denver mints: 29,592,000 at the Philadelphia mint and 11,776,000 at the Denver mint. Proof strikes were carried out at the Philadelphia mint; no 1999 dollars were struck at the San Francisco mint. The Anthony design was officially retired in 2000, when the new Sacagawea dollar entered production.

As few Susan B. Anthony dollars circulated, many remain available in uncirculated condition and are worth little above face value. However, some date and mint mark varieties are relatively valuable. The 1981 coins, having been issued only to collectors, are valued above the other circulation strikes in the series. In addition, a well-known variety of the 1979 circulation strikes from Philadelphia, on which the date appears nearer to the rim, commands a higher price than the regular issue.

All dates of the dollar also exist in proof finish. The 1999 coins were sold as standalone proof strikes, rather than as part of a larger proof set, as the 1979, 1980, and 1981 issues were offered. The 1999 proof was minted exclusively at the Philadelphia Mint, and bears a "P" mint mark, while all other proof Anthony dollars were minted at San Francisco and bear the "S" of that Mint. Some 1979 and 1981 proofs bear a mint mark which was applied to the coinage dies with a different punch, causing them to have a more legible appearance. They are considered scarce and are valued considerably higher than normal proofs of the series.

• Apollo 11 in popular culture

• Art of Frank Gasparro: 10th United States Mint Chief Engraver—Smithsonian Institution
• Susan B. Anthony Dollar