With only three or four strings and a simple diatonic fret pattern, the Appalachian dulcimer is generally regarded as one of the easiest string instruments to learn. The traditional way to play the instrument is to lay it flat on the lap and pluck or strum the strings with the right hand, while fretting with the left. Alternatively, the dulcimer may also be placed on a wooden table, which can boost volume. The instrument is generally strung with the melody string (or string pair) on the player's side of the instrument, and the bass string on the outside.

In traditional play, fretting is achieved with a "noter" — typically a short length of dowel or bamboo (see photo at left) — on the melody course, while the middle and bass strings ring as unfretted drones. This style of play is now referred to as "noter-drone" play. In some traditions, players use a feather quill with the barbs removed to strum the instrument. The frets on early mountain dulcimers were usually simple wire staples spanning only half-way across the fingerboard, meaning only the melody string course could be fretted. By the early 1960s, many dulcimer makers had abandoned staples in favour of manufactured fret wire extending across the entire width of the fingerboard. This enabled players to fret all the strings, allowing for chording and an expanded melodic range. A variety of new, "noter-less" playing styles emerged now collectively referred to as "chord-melody" play. The emergence of full-width frets also compelled makers to fret their instruments in equal temperament. The fret patterns on the older half-width-fret instruments rarely adhered to equal temperament, and intonation varied from builder to builder. With a simple melody played against the drone, these idiosyncratic scales could add warmth and a distinctive flavour to the music, but the old non-standard fret patterns often produce unacceptable dissonance when chorded.

Using modern dulcimers with full-width frets arranged for equal temperament, contemporary players have borrowed from chord theory and imported technique from other stringed instruments to greatly expand the versatility of the instrument. But a wide variety of playing styles have long been used. Jean Ritchie's The Dulcimer Book[2] has an old photograph of Mrs. Leah Smith of Big Laurel, Kentucky, playing the dulcimer with a bow instead of a pick, with the tail of the dulcimer held in the player's lap, and the headstock resting on a table pointing away from her. In their book In Search of the Wild dulcimer,[3] Robert Force and Al d'Ossché describe their preferred method as "guitar style": The dulcimer hangs from a strap around the neck, and the instrument is strummed like a guitar, although their fretting style is still overhand. They also describe playing "autoharp style" where "the dulcimer is held vertically with the headstock over the shoulder." Lynn McSpadden, in his book Four and Twenty Songs for the Mountain Dulcimer,[4] states that some players "tilt the dulcimer up sideways on their laps and strum in a guitar style." Still other dulcimer players use a fingerstyle technique, fingering chord positions with the fretting hand and rhythmically plucking individual strings with the strumming hand, creating delicate arpeggios.