The island was formerly known as Ruatan and Rattan. It is approximately 60 kilometres (37 mi) long, and less than 8 kilometres (5.0 mi) across at its widest point. The island consists of two municipalities (out of a total of four in the department):
- José Santos Guardiola in the east (named for the former president of Honduras) and
- Roatán (also including the Cayos Cochinos) further south in the west.
The most populous town of the island is Coxen Hole, capital of Roatán municipality, located in the southwest. Other important towns include French Harbour, West End, and Oak Ridge (the capital of José Santos Guardiola municipality).
The easternmost quarter of the island is separated by a channel through the mangroves that is 15 meters wide on average. This section is called Helene, or Santa Elena in Spanish. Satellite islands at the eastern end are Morat, Barbareta, and Pigeon Cay. Further west between French Harbour and Coxen Hole is Stamp Cay and Barefoot Cay.