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The scale and speed of urbanization in the mountainous regions of western China have received little attention from researchers. These cities are facing rapid population growth and severe environmental degradation. This study analyzed historical urban growth trends in this mountainous region to better understand the interaction between the spatial growth pattern and the mountainous topography. Three major factors—slope, accessibility, and land use type—were studied in light of their relationships with urban spatial growth. With the analysis of historical data as the basis, a conceptual urban spatial growth model was devised. In this model, slope, accessibility, and land use type together create resistance to urban growth, while accessibility controls the sequence of urban development. The model was tested and evaluated using historical data. It serves as a potential tool for planners to envision and assess future urban growth scenarios and their potential environmental impacts to make informed decisions.